Provider Demographics
NPI:1558039941
Name:FORMAN, BRANDY SUZANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:SUZANNE
Last Name:FORMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:SUZANNE
Other - Last Name:FOREMAN-KRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1309 SE 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4944
Mailing Address - Country:US
Mailing Address - Phone:352-843-6222
Mailing Address - Fax:
Practice Address - Street 1:1012 E SILVER SPRINGS BLVD STE B7&8
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6781
Practice Address - Country:US
Practice Address - Phone:352-405-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW119201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW11920OtherLICENSED CLINICAL SOCIAL WORKER - LCSW