Provider Demographics
NPI:1922781475
Name:GREEN, BRANDY (MSW, CSW)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N 950 E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2988
Mailing Address - Country:US
Mailing Address - Phone:801-850-3531
Mailing Address - Fax:
Practice Address - Street 1:275 W 200 N
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-5009
Practice Address - Country:US
Practice Address - Phone:385-440-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12359414-35031041C0700X
UT12359414-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical