Provider Demographics
NPI:1356933196
Name:WASHINGTON, BRANDON REGINALD (MBA, MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:REGINALD
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:MBA, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 E DEL AMO BLVD
Mailing Address - Street 2:PO BOX 399
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90714
Mailing Address - Country:US
Mailing Address - Phone:562-388-4688
Mailing Address - Fax:
Practice Address - Street 1:20745 ARLINE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1427
Practice Address - Country:US
Practice Address - Phone:310-626-7649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135209104100000X
CAASW76728104100000X, 1041C0700X
CALCSW1004671041S0200X, 1041C0700X
CAMPSS-JGDBCA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609466788OtherNPPES