Provider Demographics
NPI:1619396603
Name:BRANDAL, VALERIE SUE (PSYD, LMSW, LISW)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:SUE
Last Name:BRANDAL
Suffix:
Gender:F
Credentials:PSYD, LMSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 W SYLVANIA AVE
Mailing Address - Street 2:STE LL2
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4464
Mailing Address - Country:US
Mailing Address - Phone:231-878-9198
Mailing Address - Fax:
Practice Address - Street 1:4041 W SYLVANIA AVE
Practice Address - Street 2:STE LL2
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4464
Practice Address - Country:US
Practice Address - Phone:419-724-4233
Practice Address - Fax:877-622-7635
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010853001041C0700X
OHI.21029321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0455026Medicaid