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General NPI Number Information
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NPI Number | 1962889709
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Entity Type | Individual
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Provider Name | BRANDY ROSE SMITH MSW, LISW-S
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Gender | Female
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 700 BROOKSEDGE BLVD
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City | WESTERVILLE
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State | OH
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Zip | 43081-2820
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Country | US
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Telephone | 740-255-1209
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Fax |
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Provider Business Mailing Address
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Address Line | 11 HARDWOODS DR
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City | PATASKALA
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State | OH
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Zip | 43062-7002
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Country | US
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Telephone | 740-255-1209
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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 | I1303283
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License Number State | OH
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