Provider Demographics
NPI:1649758483
Name:MCCAULEY, BRENDA M (LSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9316
Mailing Address - Country:US
Mailing Address - Phone:304-623-5661
Mailing Address - Fax:
Practice Address - Street 1:37 ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-7057
Practice Address - Country:US
Practice Address - Phone:304-269-5220
Practice Address - Fax:304-623-5275
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00941893104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker