Individual
DR. BRANDON CHARLES DENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
4950 NORTON HEALTHCARE BLVD STE 305, LOUISVILLE, KY 40241
(502) 394-6460
(502) 394-6465
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
1654
KY
103TC0700X
Clinical Psychologist
1654
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201398770A (KOHMG)
—
IN
05
—
7100435060 (KOHMG)
—
KY
01
—
K214080-KOHMG
MEDICARE
KY
01
—
P017311-KOHMG
RR MEDICARE
KY
Enumeration date
05/05/2010
Last updated
04/24/2024
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