Provider Demographics
NPI:1053886960
Name:TONG, BRANDON (PSYD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:TONG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4807
Mailing Address - Country:US
Mailing Address - Phone:650-762-8352
Mailing Address - Fax:888-965-0579
Practice Address - Street 1:845 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4807
Practice Address - Country:US
Practice Address - Phone:650-762-8352
Practice Address - Fax:888-965-0579
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty