Provider Demographics
NPI:1467752071
Name:MARTHA ANN BRANDT, INC
Entity Type:Organization
Organization Name:MARTHA ANN BRANDT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-449-4006
Mailing Address - Street 1:4770 COVERT AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-5617
Mailing Address - Country:US
Mailing Address - Phone:812-449-4006
Mailing Address - Fax:812-475-3470
Practice Address - Street 1:4770 COVERT AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-5617
Practice Address - Country:US
Practice Address - Phone:812-449-4006
Practice Address - Fax:812-475-3470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ34002417A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty