Russell-Mervosh, Brandy

Russell-Mervosh, Brandy is an sole proprietor health care provider with primary practice located at 901 S Rogers St , Bloomington IN 47403-4760. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Russell-Mervosh, Brandy can be contacted via phone (812) 323-9890.

Contact Information

Primary practice address
901 S Rogers St Bloomington IN 47403-4760
Phone: (812) 323-9890
Fax: (812) 829-2596
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 34002977A Indiana

Profile Details

NPI number 1275504623
LBN Legal business name Russell-Mervosh, Brandy
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 1st, 2006
Last updated Feb 17th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275504623 NPPES
Indiana Other 7157432 AETNA
Indiana Other 36295 AETNA
Indiana Other 000000210144 AETNA

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