Provider Demographics
NPI:1962855486
Name:KISSANE, BRENDA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:KISSANE
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 1:7 CROMBIE ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3365
Mailing Address - Country:US
Mailing Address - Phone:978-621-0583
Mailing Address - Fax:
Practice Address - Street 1:19 FRONT ST STE 202
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3795
Practice Address - Country:US
Practice Address - Phone:978-621-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA1236621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health