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NPI Code Detail

MEDICARE: MR. DAVID I. BRANDT L.C.S.W.

MEDICARE: MR. DAVID I. BRANDT L.C.S.W.
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 Worker44SC04508900NJ

General Provider Information

NPI Number : 1649252032
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID I. BRANDT L.C.S.W.
Provider Business Mailing Address
First Line : 551 VALLEY RD
Second Line : PMB 190
City : UPPER MONTCLAIR
State : NJ
Zip : 07043-1832
Country : US
Telephone Number : 973-783-7940
Fax Number : 973-783-7940
Provider Business Practice Location Address
First Line : 51 UPPER MONTCLAIR PLZ
Second Line : RM. 12
City : UPPER MONTCLAIR
State : NJ
Zip : 07043-1343
Country : US
Telephone Number : 973-746-1933
Fax Number : 973-783-7940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2005
Last Update Date : 01/20/2012

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