Healthcare Provider Details

I. General information

NPI: 1417629965
Provider Name (Legal Business Name): BRANDY AIESHA WALKER LCSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 TELEGRAPH AVE STE 515
BERKELEY CA
94705-1151
US

IV. Provider business mailing address

2855 TELEGRAPH AVE STE 515
BERKELEY CA
94705-1151
US

V. Phone/Fax

Practice location:
  • Phone: 510-478-4029
  • Fax:
Mailing address:
  • Phone: 510-478-4029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007874
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: