Provider Demographics
NPI:1629559737
Name:FRUSCIONE, BRENDA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:FRUSCIONE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 POST OFFICE SQ
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3948
Mailing Address - Country:US
Mailing Address - Phone:978-881-4146
Mailing Address - Fax:
Practice Address - Street 1:8 POST OFFICE SQ
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3948
Practice Address - Country:US
Practice Address - Phone:978-881-4146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10240361041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool