Provider Demographics
NPI:1497765259
Name:BAHNSON, BRENDA A (MSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:BAHNSON
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 1:725 NORTH STREET
Mailing Address - Street 2:DEPT OF PSYCHIATRY PCOT
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-447-2213
Mailing Address - Fax:413-447-2176
Practice Address - Street 1:725 NORTH STREET
Practice Address - Street 2:DEPT OF PSYCHIATRY PCOT
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-447-2213
Practice Address - Fax:413-447-2176
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10226711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical