Provider Demographics
NPI:1174773675
Name:BRAND, JASON DANIEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:DANIEL
Last Name:BRAND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1713
Mailing Address - Country:US
Mailing Address - Phone:510-488-3093
Mailing Address - Fax:510-525-2102
Practice Address - Street 1:1530 5TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1713
Practice Address - Country:US
Practice Address - Phone:510-488-3093
Practice Address - Fax:510-525-2102
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS248471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical