Provider Demographics
NPI:1972679991
Name:BRANDENBERGER, MARY FRAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:FRAN
Last Name:BRANDENBERGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1295
Mailing Address - Country:US
Mailing Address - Phone:574-246-0034
Mailing Address - Fax:574-246-9794
Practice Address - Street 1:300 N MICHIGAN ST
Practice Address - Street 2:SUITE 323
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1295
Practice Address - Country:US
Practice Address - Phone:574-246-0034
Practice Address - Fax:574-246-9794
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002478A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical