Provider Demographics
NPI:1780282582
Name:BRANDWENE, AMY RACHEL (LMSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RACHEL
Last Name:BRANDWENE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E HARTSDALE AVE APT 6IW
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3265
Mailing Address - Country:US
Mailing Address - Phone:914-723-0315
Mailing Address - Fax:
Practice Address - Street 1:100 E HARTSDALE AVE APT 6IW
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3265
Practice Address - Country:US
Practice Address - Phone:914-723-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094027104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty