Provider Demographics
NPI:1740795004
Name:BREISBLATT, FAITH WOOD (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:WOOD
Last Name:BREISBLATT
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TILESTON ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-1965
Mailing Address - Country:US
Mailing Address - Phone:602-312-0703
Mailing Address - Fax:
Practice Address - Street 1:1470 BEACON ST APT A
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2613
Practice Address - Country:US
Practice Address - Phone:617-487-4909
Practice Address - Fax:617-487-4909
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1206731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical