Provider Demographics
NPI:1700906781
Name:IMANI, BRANDI (FP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:IMANI
Suffix:
Gender:F
Credentials:FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-3673
Mailing Address - Country:US
Mailing Address - Phone:602-828-7146
Mailing Address - Fax:
Practice Address - Street 1:1369 E 11TH ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-3673
Practice Address - Country:US
Practice Address - Phone:602-828-7146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker