Provider Demographics
NPI:1972973261
Name:WILSON, BRANDY (MS, MSW, MHP)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, MSW, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5761 LOUIS PRIMA DR E
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-2808
Mailing Address - Country:US
Mailing Address - Phone:985-285-8430
Mailing Address - Fax:
Practice Address - Street 1:5761 LOUIS PRIMA DR E
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128
Practice Address - Country:US
Practice Address - Phone:985-285-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11699171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator