Provider Demographics
NPI:1497764781
Name:NGUYEN, BRANDON HOANG (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:HOANG
Last Name:NGUYEN
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 1:3056 SUMMERHILL CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-3146
Mailing Address - Country:US
Mailing Address - Phone:408-838-0403
Mailing Address - Fax:
Practice Address - Street 1:134 MARTINVALE LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1318
Practice Address - Country:US
Practice Address - Phone:408-694-3883
Practice Address - Fax:408-225-8302
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA181361041C0700X
CA10882171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03924ZMedicare ID - Type Unspecified