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NPI Code Detail

MEDICARE: ANDRINA LEE BRANTLEY LCSWA

MEDICARE: ANDRINA LEE BRANTLEY LCSWA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC017280NC

General Provider Information

NPI Number : 1104564293
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRINA LEE BRANTLEY LCSWA
Provider Business Mailing Address
First Line : PO BOX 5210
Second Line :
City : GRAND FORKS
State : ND
Zip : 58206-5210
Country : US
Telephone Number : 701-205-3000
Fax Number : 701-732-2501
Provider Business Practice Location Address
First Line : 3674 S WASHINGTON ST
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-5766
Country : US
Telephone Number : 701-205-3000
Fax Number : 701-732-2501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2022
Last Update Date : 01/26/2026

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Directions to “ ANDRINA LEE BRANTLEY LCSWA” Practice Location

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