Provider Demographics
NPI:1376748467
Name:SMITH, BRANDON WALTER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:WALTER
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 STUART ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2910
Mailing Address - Country:US
Mailing Address - Phone:720-331-3062
Mailing Address - Fax:720-855-3778
Practice Address - Street 1:138 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5105
Practice Address - Country:US
Practice Address - Phone:303-393-0085
Practice Address - Fax:720-221-9287
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9928921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical