Provider Demographics
NPI:1972514875
Name:BRANDES, PEARL (LCSW)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:BRANDES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PEARL
Other - Middle Name:H
Other - Last Name:BRANDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:RADIO CITY STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10101-0034
Mailing Address - Country:US
Mailing Address - Phone:212-946-5219
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:SUITE 1408A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:212-946-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045757-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3201338OtherOXFORD
NYP3201338OtherOXFORD
NYS19760Medicare UPIN