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General NPI Number Information
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NPI Number | 1447467154
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Entity Type | Individual
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Provider Name | BRANDI NICOLE GWIN M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 05/15/2021
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Provider Practice Location Address
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Address Line | 320 DALY STREET SUITE 101
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City | DUBOIS
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State | PA
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Zip | 15801-1894
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Country | US
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Telephone | 814-591-7595
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Fax |
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Provider Business Mailing Address
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Address Line | 345 MOUNTAIN RUN RD
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City | DU BOIS
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State | PA
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Zip | 15801-7033
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Country | US
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Telephone | 814-591-7595
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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 | SW130024
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW020265
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License Number State | PA
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