Provider Demographics
NPI:1043897465
Name:EDWARDS, BRANDIE RENEE
Entity type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:RENEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRANDIE
Other - Middle Name:RENEE
Other - Last Name:MCMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15507 S NORMANDIE AVE # 738
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4013
Mailing Address - Country:US
Mailing Address - Phone:562-441-5983
Mailing Address - Fax:
Practice Address - Street 1:1149 S HILL STREET
Practice Address - Street 2:SUITE H800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015
Practice Address - Country:US
Practice Address - Phone:562-441-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA702011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty