1366727182 NPI number — BRANDY K DENISCO POIRIER MA, LPC

Table of content: BRANDY K DENISCO POIRIER MA, LPC (NPI 1366727182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366727182 NPI number — BRANDY K DENISCO POIRIER MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENISCO POIRIER
Provider First Name:
BRANDY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DENISCO
Provider Other First Name:
BRANDY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366727182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1012 SW KING AVE
Provider Second Line Business Mailing Address:
DURHAM CARRIAGE HOUSE, SUITE B
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97205-1106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-313-5765
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1012 SW KING AVE
Provider Second Line Business Practice Location Address:
DURHAM CARRIAGE HOUSE, SUITE B
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97205-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-313-5765
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C2651 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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