Provider Demographics
NPI:1598751760
Name:BRANDIS, KRISTINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:
Last Name:BRANDIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:DOWLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:208 WICKERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-7806
Mailing Address - Country:US
Mailing Address - Phone:516-457-2717
Mailing Address - Fax:866-528-7166
Practice Address - Street 1:401 E 12TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-3403
Practice Address - Country:US
Practice Address - Phone:302-576-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0697031041C0700X
DEQ1-00017211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY95429AMedicare ID - Type UnspecifiedGHI MEDICARE
NYN22V71Medicare ID - Type UnspecifiedEMPIRE MEDICARE