Provider Demographics
NPI:1093494817
Name:BRANDY, MERVIN L JR (MSW, LCSWA)
Entity Type:Individual
Prefix:MR
First Name:MERVIN
Middle Name:L
Last Name:BRANDY
Suffix:JR
Gender:M
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CASTLEWOOD DR APT 436
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1232
Mailing Address - Country:US
Mailing Address - Phone:336-989-9786
Mailing Address - Fax:
Practice Address - Street 1:2310 S MIAMI BLVD STE 231
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-4900
Practice Address - Country:US
Practice Address - Phone:336-647-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0172581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical