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General NPI Number Information
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NPI Number | 1003634486
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Entity Type | Individual
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Provider Name | BOBBI BRANDAU
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Gender | Female
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 62 COIT ST
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City | NEW LONDON
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State | CT
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Zip | 06320-5923
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Country | US
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Telephone | 860-447-1717
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Fax |
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Provider Business Mailing Address
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Address Line | 110 DORSET LN
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City | MADISON
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State | CT
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Zip | 06443-1685
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Country | US
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Telephone | 203-927-3968
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 9063
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License Number State | CT
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