Provider Demographics
NPI:1538808852
Name:CASANOVA, BRANDY (MED, DBH)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:MED, DBH
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6323 MONITOR DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4557
Mailing Address - Country:US
Mailing Address - Phone:623-521-0361
Mailing Address - Fax:
Practice Address - Street 1:35 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3606
Practice Address - Country:US
Practice Address - Phone:603-556-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA