Provider Demographics
NPI:1700428505
Name:JONES-SHAW, BRANDI NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:NICOLE
Last Name:JONES-SHAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11251 RANCHO CARMEL DR UNIT 501693
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-8069
Mailing Address - Country:US
Mailing Address - Phone:619-630-0262
Mailing Address - Fax:
Practice Address - Street 1:11251 RANCHO CARMEL DR UNIT 501693
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92150-8069
Practice Address - Country:US
Practice Address - Phone:619-630-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1291911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW129191OtherBOARD OF BEHAVIORAL SCIENCES