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NPI Code Detail

MEDICARE: BRANDIE AJISEFINNI LCSW

MEDICARE: BRANDIE AJISEFINNI LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorASW80534CA
21041C0700XClinical Social Worker106581CA
31041C0700XClinical Social WorkerLCSW106581CA
4104100000XSocial WorkerSWB-2023-0384NM

General Provider Information

NPI Number : 1376076372
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDIE AJISEFINNI LCSW
Provider Business Mailing Address
First Line : PO BOX 21883
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87154-1883
Country : US
Telephone Number : 510-939-1931
Fax Number :
Provider Business Practice Location Address
First Line : 1031 LAMBERTON PL NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87107-1641
Country : US
Telephone Number : 505-272-8551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2017
Last Update Date : 04/05/2024

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