Provider Demographics
NPI:1013624675
Name:BRANDON, BIANCA JASMIN (LCSW)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:JASMIN
Last Name:BRANDON
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 1:5789 PIONEER MESA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-8795
Mailing Address - Country:US
Mailing Address - Phone:720-341-4167
Mailing Address - Fax:
Practice Address - Street 1:7400 E ORCHARD RD # 2700N
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2528
Practice Address - Country:US
Practice Address - Phone:720-341-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099255711041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09925571OtherLCSW