MEDICARE: MARK BRAND LCSW

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	776	CO

General Provider Information

NPI Number	:	1689827149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK BRAND LCSW

Provider Business Mailing Address
First Line	:	7500 W MISSISSIPPI AVE
Second Line	:	STE. B-40
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4550
Country	:	US
Telephone Number	:	303-317-8945
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 W MISSISSIPPI AVE
Second Line	:	STE. B-40
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4550
Country	:	US
Telephone Number	:	303-317-8945
Fax Number	:

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

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	10/28/2008

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