Healthcare Provider Details

I. General information

NPI: 1841648433
Provider Name (Legal Business Name): BRANDON MICHAEL JONES MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 RING RD STE 114
ELIZABETHTOWN KY
42701-5930
US

IV. Provider business mailing address

235 NORTH AVE
PENN YAN NY
14527-1051
US

V. Phone/Fax

Practice location:
  • Phone: 270-979-5943
  • Fax: 270-979-5944
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001687
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: