Brandi Blue, LCSW
Individual provider Active NPI Social Worker · Nellis Afb, NV
NPI 1255789574 · NPPES record last updated Aug 4, 2023
Key facts
- NPI
- 1255789574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 7946-S (NV)
- Practice address
- 4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600 - Phone
- (702) 653-3880
- NPI assigned
- May 26, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220712003424 | NV | Order and Referring Only - Clinical Social Worker | 0749661437 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7946-S | NV | MD | Social Worker |
| RBT-17-37944 | NV | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-17-37944 | NV | |
| Rehabilitation Practitioner | 225400000X | |||
| Social Worker | 104100000X | 7946-S | NV | Yes |
Addresses
Primary practice location
4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600
Mailing address
4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600
Phone (702) 653-3880
Other practice location 1
6039 Eldora Ave Ste A
Las Vegas, NV 89146
Phone (702) 248-8866 ext. 259
Other practice location 2
2110 E Flamingo Rd # 150
Las Vegas, NV 89119-5190
Phone (702) 270-3219
Other providers in Nellis Afb, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.