Provider Demographics
NPI:1497406763
Name:BRASH, PETER ANDREW
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ANDREW
Last Name:BRASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-3446
Mailing Address - Country:US
Mailing Address - Phone:781-724-7001
Mailing Address - Fax:
Practice Address - Street 1:360 MERRIMACK ST STE 120
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1740
Practice Address - Country:US
Practice Address - Phone:978-794-7966
Practice Address - Fax:978-794-9890
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS21646202OtherMASSACHUSETTS DRIVER'S LICENSE