Active NPI
Allison Brazendale, PSY.D.
- Clinical Psychologist
- Columbia, SC
National Provider Identifier
1629468491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1319
- Practice address
- 1505 Blanding St
Columbia, SC 29201-2906 - Phone
- (954) 913-6306
- NPI assigned
- Jan 30, 2015
- Last updated
- Apr 8, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1319 | SC | Primary |
Addresses
Primary practice location
1505 Blanding St
Columbia, SC 29201-2906
Mailing address
6275 NW 96TH Ter
Parkland, FL 33076-1815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554681600000",
"number": "1629468491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6275 NW 96TH TER",
"city": "PARKLAND",
"state": "FL",
"postal_code": "330761815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 BLANDING ST",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292012906",
"telephone_number": "954-913-6306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAZENDALE",
"first_name": "ALLISON",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-30",
"last_updated": "2019-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SC",
"license": "1319",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.