Provider Demographics
NPI:1265009807
Name:BRASSARD, EMILY D (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:D
Last Name:BRASSARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SAWYER LN
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-4252
Mailing Address - Country:US
Mailing Address - Phone:845-417-7884
Mailing Address - Fax:
Practice Address - Street 1:1120 ROUTE 72
Practice Address - Street 2:SUITE 300
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-0805
Practice Address - Country:US
Practice Address - Phone:856-372-0994
Practice Address - Fax:856-861-1364
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089691-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY084390-01OtherLMSW LICENSE
NY089691-01OtherLCSW LICENSE