1477853182 NPI number — MARCY SWIATEK BRANDNER MFT

Table of content: MARCY SWIATEK BRANDNER MFT (NPI 1477853182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477853182 NPI number — MARCY SWIATEK BRANDNER MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANDNER
Provider First Name:
MARCY
Provider Middle Name:
SWIATEK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWIATEK
Provider Other First Name:
MARCY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477853182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18928 RAILROAD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SONOMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95476-4536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-772-9790
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19343 SONOMA HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SONOMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-337-2394
Provider Business Practice Location Address Fax Number:
775-337-9570
Provider Enumeration Date:
10/27/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 01240 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFT.0001729 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: LMFT111964 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)