Provider Demographics
NPI:1063715977
Name:BRANDT, AMY REBECCA (LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:REBECCA
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 UNIVERSITY AVE W STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1854
Mailing Address - Country:US
Mailing Address - Phone:651-644-4100
Mailing Address - Fax:651-644-4885
Practice Address - Street 1:2324 UNIVERSITY AVE W STE 120
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:651-644-4100
Practice Address - Fax:651-644-4885
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical