Provider Demographics
NPI:1871374959
Name:TARZIS, BRANDON A (MHC-LP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:A
Last Name:TARZIS
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SAINT PAULS PL APT 3D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1372
Mailing Address - Country:US
Mailing Address - Phone:614-537-1095
Mailing Address - Fax:
Practice Address - Street 1:27 BARROW ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3823
Practice Address - Country:US
Practice Address - Phone:212-242-4140
Practice Address - Fax:212-929-9727
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP125266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health