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Individual
MS. MARA J BRANDON
Active
Individual
MS. MARA J BRANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CASAC 2
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
21232
NY
104100000X
Social Worker
084080
NY
1041C0700X
Clinical Social Worker
Primary
085699
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00695941
—
NY
01
—
5631735
CIGNA
NY
Enumeration date
10/29/2013
Last updated
03/17/2018
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