Provider Demographics
NPI:1518170257
Name:ALLEN, BRANDY T (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:T
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:T
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1629 CENTRAL ST STE 3
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1693
Mailing Address - Country:US
Mailing Address - Phone:866-754-4973
Mailing Address - Fax:781-436-3032
Practice Address - Street 1:1629 CENTRAL ST STE 3
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1693
Practice Address - Country:US
Practice Address - Phone:866-754-4973
Practice Address - Fax:781-436-3032
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA1196511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health