Healthcare Provider Details

I. General information

NPI: 1093023012
Provider Name (Legal Business Name): BRANDON JAMES ERCANBRACK LCSW, MAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 UNIVERSITY LAKE DR
ANCHORAGE AK
99508-4658
US

IV. Provider business mailing address

3801 UNIVERSITY LAKE DR
ANCHORAGE AK
99508-4658
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-2492
  • Fax: 907-729-3950
Mailing address:
  • Phone: 907-729-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123302
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: