Provider Demographics
NPI:1871718015
Name:BRANDT, SCOTT DAVID
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:BRANDT
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:DAVID
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3138 WARREN LN
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4285
Mailing Address - Country:US
Mailing Address - Phone:800-391-7010
Mailing Address - Fax:916-939-7723
Practice Address - Street 1:2360 E BIDWELL ST
Practice Address - Street 2:SUITE 107
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3406
Practice Address - Country:US
Practice Address - Phone:800-391-7010
Practice Address - Fax:916-939-7723
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10838103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical