Individual
BRANDON LAWRENCE MEDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
301 S CAMINO DEL PUEBLO, BERNALILLO, NM 87004-6276
(505) 867-2383
Mailing address
2504 CAMINO ENTRADA, SANTA FE, NM 87507-4851
(610) 620-4091
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M-11397
NM
1041C0700X
Clinical Social Worker
Primary
SWB-2024-0580
NM
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
11/19/2020
Last updated
01/09/2025
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