Provider Demographics
NPI:1760104699
Name:RICKE, BRANDON HEREFORD (CADC-R, CRM, BBA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:HEREFORD
Last Name:RICKE
Suffix:
Gender:M
Credentials:CADC-R, CRM, BBA
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:HEREFORD
Other - Last Name:RICHARD-RICKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:855 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-5408
Mailing Address - Country:US
Mailing Address - Phone:888-793-3500
Mailing Address - Fax:860-793-3369
Practice Address - Street 1:855 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-5408
Practice Address - Country:US
Practice Address - Phone:888-793-3500
Practice Address - Fax:860-793-3369
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)