Provider Demographics
NPI:1366688046
Name:MANDES-BRASILI, ELISA (MSW)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:MANDES-BRASILI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-1159
Mailing Address - Country:US
Mailing Address - Phone:978-544-2148
Mailing Address - Fax:978-544-2196
Practice Address - Street 1:131 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1150
Practice Address - Country:US
Practice Address - Phone:978-544-2148
Practice Address - Fax:978-544-2196
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1051351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical