Provider Demographics
NPI:1992948491
Name:BRAWNER, BRANDON LOWRY (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LOWRY
Last Name:BRAWNER
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:DR
Other - First Name:BRANDON
Other - Middle Name:
Other - Last Name:BRAWNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:4194 OPAL ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2618
Mailing Address - Country:US
Mailing Address - Phone:510-207-0721
Mailing Address - Fax:
Practice Address - Street 1:2220 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611
Practice Address - Country:US
Practice Address - Phone:510-910-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28143101YM0800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health