Provider Demographics
NPI:1841561909
Name:CONDON, BRIAN JR (BRIAN CONDON LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:CONDON
Suffix:JR
Gender:M
Credentials:BRIAN CONDON LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 HERBERT DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1445
Mailing Address - Country:US
Mailing Address - Phone:301-706-0187
Mailing Address - Fax:
Practice Address - Street 1:333 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1253
Practice Address - Country:US
Practice Address - Phone:609-377-8118
Practice Address - Fax:609-377-8120
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054877001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical