Healthcare Provider Details

I. General information

NPI: 1225744014
Provider Name (Legal Business Name): BRANDI PACIFICO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 ARROYO CIR
GILROY CA
95020-7303
US

IV. Provider business mailing address

8325 WREN AVE
GILROY CA
95020-4118
US

V. Phone/Fax

Practice location:
  • Phone: 408-848-4640
  • Fax:
Mailing address:
  • Phone: 815-954-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: