MEDICARE: MS. KANDI K BRELSFORD MSW

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
1	1041C0700X	Clinical Social Worker	I528	OH
2	1041C0700X	Clinical Social Worker	I.0000528-SUPV	OH

General Provider Information

NPI Number	:	1326122656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KANDI K BRELSFORD MSW

Provider Business Mailing Address
First Line	:	601 S EDWIN C MOSES BLVD, 4TH FLOOR NW BLDG
Second Line	:	SAMARITAN BEHAVIORAL HEALTH INC
City	:	DAYTON
State	:	OH
Zip	:	45417-3424
Country	:	US
Telephone Number	:	937-734-8333
Fax Number	:	937-734-4343

Provider Business Practice Location Address
First Line	:	601 S EDWIN C MOSES BLVD
Second Line	:	SAMARITAN BEHAVIORAL HEALTH, INC.,
City	:	DAYTON
State	:	OH
Zip	:	45417-3424
Country	:	US
Telephone Number	:	513-984-1800
Fax Number	:	513-984-4909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	03/23/2017

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