Provider Demographics
NPI:1225064025
Name:GREGG, BRANDON G (MSSW, CSW)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:G
Last Name:GREGG
Suffix:
Gender:M
Credentials:MSSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-1556
Mailing Address - Country:US
Mailing Address - Phone:859-835-2573
Mailing Address - Fax:
Practice Address - Street 1:503 WATSON RD
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1556
Practice Address - Country:US
Practice Address - Phone:859-835-2573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184607OtherMEDICARE GROUP NUMBER
KY610661458OtherFEDERAL TAX ID NUMBER