Provider Demographics
NPI:1790590388
Name:SURRIDGE, BRANDI (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:SURRIDGE
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 1:61 VANDENBURGH AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6036
Mailing Address - Country:US
Mailing Address - Phone:802-745-7651
Mailing Address - Fax:
Practice Address - Street 1:200 GREAT OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5971
Practice Address - Country:US
Practice Address - Phone:518-218-1188
Practice Address - Fax:518-218-1988
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0987851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical