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General NPI Number Information
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NPI Number | 1083912901
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Entity Type | Organization
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Legal Business Name | ROBERT BRANDENBURG
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 2225 N MCCARRAN BLVD
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City | SPARKS
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State | NV
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Zip | 89431-3365
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Country | US
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Telephone | 775-359-1199
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Fax | 775-359-1195
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Provider Business Mailing Address
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Address Line | 2225 N MCCARRAN BLVD
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City | SPARKS
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State | NV
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Zip | 89431-3365
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Country | US
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Telephone | 775-359-1199
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Fax | 775-359-1195
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. ROBERT LYNN BRANDENBURG SR.
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Credential | LCSW
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Telephone | 775-359-1199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2092-C
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License Number State | NV
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