Provider Demographics
NPI:1083839146
Name:BRAZ, ANNA (LICSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BRAZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ARMISTICE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5354
Mailing Address - Country:US
Mailing Address - Phone:401-205-4857
Mailing Address - Fax:508-342-7490
Practice Address - Street 1:110 ARMISTICE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5354
Practice Address - Country:US
Practice Address - Phone:401-205-4857
Practice Address - Fax:508-342-7490
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW015591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134OtherGROUP NUMBER