Provider Demographics
NPI:1447419064
Name:BRIGHAM, MOLLY KEENAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:KEENAN
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:KEENAN
Other - Last Name:MARIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 DUNNING WAY APT 110
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3748
Mailing Address - Country:US
Mailing Address - Phone:617-519-0167
Mailing Address - Fax:
Practice Address - Street 1:2 DUNNING WAY APT 110
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3748
Practice Address - Country:US
Practice Address - Phone:617-519-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical