Provider Demographics
NPI:1073124020
Name:BRANDON, NADIA THERESE (LICSW, LPN)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:THERESE
Last Name:BRANDON
Suffix:
Gender:F
Credentials:LICSW, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 COMMONWEALTH AVE APT 21
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4738
Mailing Address - Country:US
Mailing Address - Phone:240-381-8140
Mailing Address - Fax:
Practice Address - Street 1:1269 BEACON ST 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:855-505-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225818104100000X
MA1259751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker