Provider Demographics
NPI:1871188615
Name:RUBY, BRANDON (CSW-I)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:RUBY
Suffix:
Gender:M
Credentials:CSW-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 TERMINAL WAY STE 217
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3258
Mailing Address - Country:US
Mailing Address - Phone:775-624-8200
Mailing Address - Fax:
Practice Address - Street 1:1201 TERMINAL WAY STE 217
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3258
Practice Address - Country:US
Practice Address - Phone:775-624-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-16511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical