Provider Demographics
NPI:1831734888
Name:BOUSQUET, BRANDY (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:BOUSQUET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 BUCKLEY HWY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:CT
Mailing Address - Zip Code:06076-4802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1065 BUCKLEY HWY
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:CT
Practice Address - Zip Code:06076-4802
Practice Address - Country:US
Practice Address - Phone:508-341-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical