Healthcare Provider Details

I. General information

NPI: 1174773675
Provider Name (Legal Business Name): JASON DANIEL BRAND LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 5TH ST
BERKELEY CA
94710-1713
US

IV. Provider business mailing address

1530 5TH ST
BERKELEY CA
94710-1713
US

V. Phone/Fax

Practice location:
  • Phone: 510-488-3093
  • Fax: 510-525-2102
Mailing address:
  • Phone: 510-488-3093
  • Fax: 510-525-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS24847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: