Provider Demographics
NPI:1659258903
Name:BRANDVEEN, DOMINIC (RBT)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:BRANDVEEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 REYNOLDS PL APT G
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-2291
Mailing Address - Country:US
Mailing Address - Phone:336-500-9574
Mailing Address - Fax:
Practice Address - Street 1:823 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1510
Practice Address - Country:US
Practice Address - Phone:336-900-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician