Provider Demographics
NPI:1790876209
Name:BRANDY, SUSAN M (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:BRANDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:BRANDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2715 PORTER ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2458
Mailing Address - Country:US
Mailing Address - Phone:831-476-3638
Mailing Address - Fax:831-439-8680
Practice Address - Street 1:2715 PORTER ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2458
Practice Address - Country:US
Practice Address - Phone:831-476-3638
Practice Address - Fax:831-439-8680
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS138621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical