Provider Demographics
NPI:1285800607
Name:SMITH, BRANDI GWEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:GWEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 414 BOX 309
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09173-0309
Mailing Address - Country:US
Mailing Address - Phone:49947-283-4907
Mailing Address - Fax:
Practice Address - Street 1:UNIT 26610
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244-6610
Practice Address - Country:US
Practice Address - Phone:49931-889-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070145251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000OtherUPIN MEDDAC