Provider Demographics
NPI:1598052656
Name:BRAZAO, CESALTINO J (BA)
Entity Type:Individual
Prefix:MR
First Name:CESALTINO
Middle Name:J
Last Name:BRAZAO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1650
Mailing Address - Country:US
Mailing Address - Phone:774-274-6567
Mailing Address - Fax:
Practice Address - Street 1:142 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3104
Practice Address - Country:US
Practice Address - Phone:508-941-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker