Provider Demographics
NPI:1972043339
Name:HACKETT, BRENDAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:
Last Name:HACKETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W 104TH ST
Mailing Address - Street 2:APT 35
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 W 104TH ST
Practice Address - Street 2:APT 35
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4231
Practice Address - Country:US
Practice Address - Phone:917-697-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0851371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical