Provider Demographics
NPI:1821856022
Name:BRENDAN TWIST LCSW PLLC
Entity Type:Organization
Organization Name:BRENDAN TWIST LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TWIST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-428-7140
Mailing Address - Street 1:4 CAMEO CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2231
Mailing Address - Country:US
Mailing Address - Phone:516-428-7140
Mailing Address - Fax:
Practice Address - Street 1:340 ROUTE 202 STE H
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3289
Practice Address - Country:US
Practice Address - Phone:516-428-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty