Provider Demographics
NPI:1548409162
Name:BOX, BRANDY ALLISON (LISW, MSW)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:ALLISON
Last Name:BOX
Suffix:
Gender:F
Credentials:LISW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300G EL PASEO RD # 135
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-6024
Mailing Address - Country:US
Mailing Address - Phone:575-642-2167
Mailing Address - Fax:575-522-3689
Practice Address - Street 1:506 S MAIN ST STE 420
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1236
Practice Address - Country:US
Practice Address - Phone:575-532-9050
Practice Address - Fax:575-522-3689
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX065031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical