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NPI Code Detail

MEDICARE: MR. BRANDON GLEN HIGHSMITH LCSW

MEDICARE: MR. BRANDON GLEN HIGHSMITH 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
11041C0700XClinical Social WorkerSW20073FL

General Provider Information

NPI Number : 1710739891
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRANDON GLEN HIGHSMITH LCSW
Provider Business Mailing Address
First Line : 1200 RIVERPLACE BLVD STE 105-1173
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-9046
Country : US
Telephone Number : 904-903-6674
Fax Number :
Provider Business Practice Location Address
First Line : 1200 RIVERPLACE BLVD STE 1051173
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-9046
Country : US
Telephone Number : 904-903-6674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2024
Last Update Date : 04/13/2026

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