Provider Demographics
NPI:1356585038
Name:MAIN, BRIAN JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:MAIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5007
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93216-5007
Mailing Address - Country:US
Mailing Address - Phone:661-721-2345
Mailing Address - Fax:
Practice Address - Street 1:2737 WEST CECIL AVENUE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215
Practice Address - Country:US
Practice Address - Phone:619-316-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program