Provider Demographics
NPI:1811025935
Name:BRANDON, BARBARA (SW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BRANDON
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 90TH ST SW
Mailing Address - Street 2:EDWARD GONZALES ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-7710
Mailing Address - Country:US
Mailing Address - Phone:505-831-6214
Mailing Address - Fax:
Practice Address - Street 1:554 90TH ST SW
Practice Address - Street 2:EDWARD GONZALES ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-7710
Practice Address - Country:US
Practice Address - Phone:505-831-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 4429104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73332Medicaid