Provider Demographics
NPI:1982372900
Name:ANDERSON, DANIELLE BRANDT (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:BRANDT
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ALLISON
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PSC 1005 BOX 110185
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:09593-9998
Mailing Address - Country:US
Mailing Address - Phone:757-458-2998
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL GUANTANAMO BAY
Practice Address - Street 2:PSC 1005 110185
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34009
Practice Address - Country:US
Practice Address - Phone:757-458-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040162531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical