Provider Demographics
NPI:1346881745
Name:THATCHER, BRIANA (LSW)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:THATCHER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:84 PARK AVE STE E114
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1176
Mailing Address - Country:US
Mailing Address - Phone:908-751-1208
Mailing Address - Fax:
Practice Address - Street 1:84 PARK AVE STE E114
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1176
Practice Address - Country:US
Practice Address - Phone:908-751-1208
Practice Address - Fax:908-824-2369
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06023600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker