Provider Demographics
NPI:1407989502
Name:RUTAN, BRANDI CELESTE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:CELESTE
Last Name:RUTAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:CELESTE
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1848 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2875
Mailing Address - Country:US
Mailing Address - Phone:828-692-6178
Mailing Address - Fax:828-692-2365
Practice Address - Street 1:571 S ALLEN RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731
Practice Address - Country:US
Practice Address - Phone:828-692-6178
Practice Address - Fax:828-356-3998
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC009934104100000X, 1041C0700X
SC11720104100000X
GACSW0058511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW005851OtherLICENSED CLINICAL SOCIAL WORKER
SC11720OtherLICENSED INDEPENDENT SOCIAL WORKER
NCC009934OtherLICENSED CLINICAL SOCIAL WORKER