Basic Information
Provider Information | |||||||||
NPI: | 1477853182 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BRANDNER | ||||||||
FirstName: | MARCY | ||||||||
MiddleName: | SWIATEK | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MFT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SWIATEK | ||||||||
OtherFirstName: | MARCY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MFT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 18928 RAILROAD AVE | ||||||||
Address2: |   | ||||||||
City: | SONOMA | ||||||||
State: | CA | ||||||||
PostalCode: | 954764536 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7757729790 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 19343 SONOMA HIGHWAY | ||||||||
Address2: |   | ||||||||
City: | SONOMA | ||||||||
State: | CA | ||||||||
PostalCode: | 95476 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7753372394 | ||||||||
FaxNumber: | 7753379570 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/27/2010 | ||||||||
LastUpdateDate: | 04/28/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/28/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X |   |   | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 01240 | NV | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 106H00000X | MFT.0001729 | CO | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 106H00000X | LMFT111964 | CA | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.