Provider Demographics
NPI:1396085064
Name:BRANDON, MARILYN FAYE (LISW-S, LICDC)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:FAYE
Last Name:BRANDON
Suffix:
Gender:F
Credentials:LISW-S, LICDC
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:FAYE
Other - Last Name:ABRAHAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3979 HAMBLEN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-4801
Mailing Address - Country:US
Mailing Address - Phone:513-410-3944
Mailing Address - Fax:
Practice Address - Street 1:7577 CENTRAL PARKE BLVD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6810
Practice Address - Country:US
Practice Address - Phone:513-770-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL.00086721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical