Provider Demographics
NPI:1376076372
Name:AJISEFINNI, BRANDIE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:
Last Name:AJISEFINNI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21883
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-1883
Mailing Address - Country:US
Mailing Address - Phone:510-939-1931
Mailing Address - Fax:
Practice Address - Street 1:1031 LAMBERTON PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1641
Practice Address - Country:US
Practice Address - Phone:505-272-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW80534101YM0800X
CA1065811041C0700X
CALCSW1065811041C0700X
NMSWB-2023-0384104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical