Provider Demographics
NPI:1467006270
Name:WHEELER, BRANDY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 DENNISON ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1329
Mailing Address - Country:US
Mailing Address - Phone:978-491-9016
Mailing Address - Fax:
Practice Address - Street 1:124 DENNISON ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1329
Practice Address - Country:US
Practice Address - Phone:978-491-9016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10263511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical