Provider Demographics
NPI:1902650260
Name:GASPAR, BRANDON JOAQUIN (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JOAQUIN
Last Name:GASPAR
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 1:3948 S BELLA NOTTE DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-7648
Mailing Address - Country:US
Mailing Address - Phone:928-210-7400
Mailing Address - Fax:
Practice Address - Street 1:3948 S BELLA NOTTE DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-7648
Practice Address - Country:US
Practice Address - Phone:928-210-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ220791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical