Active NPI
Brandon S. Gwilliam, LCSW
- Clinical Social Worker
- Provo, UT
National Provider Identifier
1942550488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 73813593501
- Practice address
- 1807 N 1120 W
Provo, UT 84604-1180 - Phone
- (801) 377-1117
- Fax
- (801) 377-0227
- NPI assigned
- Sep 12, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 73813593501 | UT | Primary |
Addresses
Primary practice location
1807 N 1120 W
Provo, UT 84604-1180
Mailing address
1807 N 1120 W
Provo, UT 84604-1180
Phone (801) 377-1117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73813593501 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347408000000",
"number": "1942550488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1807 N 1120 W",
"city": "PROVO",
"state": "UT",
"postal_code": "846041180",
"telephone_number": "801-377-1117",
"fax_number": "801-377-0227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1807 N 1120 W",
"city": "PROVO",
"state": "UT",
"postal_code": "846041180",
"telephone_number": "801-377-1117",
"fax_number": "801-377-0227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWILLIAM",
"first_name": "BRANDON",
"middle_name": "S.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-12",
"last_updated": "2012-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "73813593501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.