Provider Demographics
NPI:1053777045
Name:BRANDOW, RICHARD KERRY
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KERRY
Last Name:BRANDOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10555 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2705
Mailing Address - Country:US
Mailing Address - Phone:720-350-2992
Mailing Address - Fax:303-279-0290
Practice Address - Street 1:16625 W 50TH AVE.
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:720-350-2992
Practice Address - Fax:303-279-0290
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional