Individual
GERALDINE BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
408 FAIRVIEW ST, MULLENS, WV 25882-1324
(681) 222-9896
Mailing address
408 FAIRVIEW ST, MULLENS, WV 25882-1324
(681) 222-9896
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
AP00942082
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP00942082
BOARD OF SOCIAL WORK
WV
Enumeration date
09/24/2015
Last updated
02/16/2016
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