Healthcare Provider Details

I. General information

NPI: 1447467154
Provider Name (Legal Business Name): BRANDI NICOLE GWIN M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/15/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 DALY STREET SUITE 101
DUBOIS PA
15801-1894
US

IV. Provider business mailing address

345 MOUNTAIN RUN RD
DU BOIS PA
15801-7033
US

V. Phone/Fax

Practice location:
  • Phone: 814-591-7595
  • Fax:
Mailing address:
  • Phone: 814-591-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW130024
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020265
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: