Provider Demographics
NPI:1023599834
Name:BRAINERD, MARY KATHERINE (MSW PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:BRAINERD
Suffix:
Gender:F
Credentials:MSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BLANDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01008-9516
Mailing Address - Country:US
Mailing Address - Phone:413-848-2332
Mailing Address - Fax:
Practice Address - Street 1:28 NORTH ST
Practice Address - Street 2:
Practice Address - City:BLANDFORD
Practice Address - State:MA
Practice Address - Zip Code:01008-9516
Practice Address - Country:US
Practice Address - Phone:413-848-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1022921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty