Healthcare Provider Details

I. General information

NPI: 1598751760
Provider Name (Legal Business Name): KRISTINA BRANDIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA DOWLING LCSW

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 12TH ST
WILMINGTON DE
19801-3403
US

IV. Provider business mailing address

208 WICKERBERRY DR
MIDDLETOWN DE
19709-7806
US

V. Phone/Fax

Practice location:
  • Phone: 302-576-8080
  • Fax:
Mailing address:
  • Phone: 516-457-2717
  • Fax: 866-528-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069703
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001721
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: