Provider Demographics
NPI:1750694105
Name:HARRISON, BRIAN WHITE SR (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WHITE
Last Name:HARRISON
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:53 EAGLE ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4776
Mailing Address - Country:US
Mailing Address - Phone:413-236-5656
Mailing Address - Fax:413-499-6572
Practice Address - Street 1:53 EAGLE STREET
Practice Address - Street 2:IST FLOOR
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-1201
Practice Address - Country:US
Practice Address - Phone:413-236-5656
Practice Address - Fax:413-499-6572
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20102581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical