Brandon William Maynard, PSYD, MA
Individual provider Active NPI Clinical Psychologist · Vandenberg Afb, CA
NPI 1114215746 · NPPES record last updated Dec 2, 2024
Key facts
- NPI
- 1114215746
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 12540358-2501 (UT)
- Practice address
- 338 S Dakota Ave
Vandenberg Afb, CA 93437-6307 - Phone
- (805) 606-8217
- NPI assigned
- Jul 18, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12540358-2501 | UT | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 12540358-2501 | UT | Yes |
| Clinical Psychologist | 103TC0700X | 668 | WY |
Addresses
Primary practice location
338 S Dakota Ave
Vandenberg Afb, CA 93437-6307
Mailing address
338 S Dakota Ave
Vandenberg Afb, CA 93437-6307
Phone (805) 606-8217
Other providers in Vandenberg Afb, CA
- Carlene Latouche
- Arnold Lazaga
- Amy Marie Leiter
- Brigette Jo Lugo
- Catherine Margetiak
- Phillip Matthew McPeak
- Lawrence Daniel Merket
- Skyler Brooke Mott
- Alan Jon Napoles
- Maria Rhodora Sison Pablo
All providers in Vandenberg Afb, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.