Provider Demographics
NPI:1821103532
Name:RASH, BRETT A (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:A
Last Name:RASH
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MDG
Mailing Address - Street 2:307 BOATNER ROAD
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542
Mailing Address - Country:US
Mailing Address - Phone:850-883-9957
Mailing Address - Fax:850-883-8133
Practice Address - Street 1:325TH MEDICAL GROUP
Practice Address - Street 2:340 MAGNOLIA CIRCLE, BLDG. 1465
Practice Address - City:TYNDALL AFB
Practice Address - State:FL
Practice Address - Zip Code:32403-5604
Practice Address - Country:US
Practice Address - Phone:850-283-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005900A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical