Provider Demographics
NPI:1629517032
Name:BRANDT, ALISSA JOAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:JOAN
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:JOAN
Other - Last Name:BRANDT-CHUBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1436
Mailing Address - Country:US
Mailing Address - Phone:717-233-1681
Mailing Address - Fax:717-234-8258
Practice Address - Street 1:3333 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1436
Practice Address - Country:US
Practice Address - Phone:717-233-1681
Practice Address - Fax:717-234-8258
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0192371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical