Provider Demographics
NPI:1326262791
Name:GIESSMANN, BRENT T (LADC-I, CADAC)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:T
Last Name:GIESSMANN
Suffix:
Gender:M
Credentials:LADC-I, CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474
Mailing Address - Country:US
Mailing Address - Phone:781-646-3800
Mailing Address - Fax:781-646-3188
Practice Address - Street 1:299 BROADWAY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474
Practice Address - Country:US
Practice Address - Phone:781-646-3800
Practice Address - Fax:781-646-3188
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)