Provider Demographics
NPI:1083270102
Name:HARVEY, BRENDA J
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JEAN
Other - Last Name:JOHNSON-GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MILLERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01349-1211
Mailing Address - Country:US
Mailing Address - Phone:413-522-7024
Mailing Address - Fax:
Practice Address - Street 1:131 KING ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3234
Practice Address - Country:US
Practice Address - Phone:413-665-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator