Provider Demographics
NPI:1487842225
Name:BRAND, MARY C (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:BRAND
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 1:5247 MYRTLEWOOD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-4617
Mailing Address - Country:US
Mailing Address - Phone:941-342-8540
Mailing Address - Fax:941-342-8504
Practice Address - Street 1:3800 S TAMIAMI TRL
Practice Address - Street 2:315
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6908
Practice Address - Country:US
Practice Address - Phone:941-342-8540
Practice Address - Fax:941-342-8504
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW62611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8609Medicare PIN