Provider Demographics
NPI:1760013981
Name:KWASNIK, BRANDON (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:KWASNIK
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 1:141 DISCOVERY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4134
Mailing Address - Country:US
Mailing Address - Phone:406-210-7916
Mailing Address - Fax:
Practice Address - Street 1:141 DISCOVERY DR STE 103
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4134
Practice Address - Country:US
Practice Address - Phone:406-210-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-425871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical