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General NPI Number Information
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NPI Number | 1568519759
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Entity Type | Individual
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Provider Name | LISA ANN BRANDI LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 06/28/2014
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Provider Practice Location Address
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Address Line | 755 WAVERLY AVE STE 204A
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City | HOLTSVILLE
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State | NY
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Zip | 11742-1190
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Country | US
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Telephone | 631-332-9610
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CHESTNUT PL
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City | MASTIC BEACH
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State | NY
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Zip | 11951-7202
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Country | US
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Telephone | 631-772-8684
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 071307
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License Number State | NY
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