Provider Demographics
NPI:1881914497
Name:BRAZIL, JESSICA (LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:BRAZIL
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:P.O. BOX 1977
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753
Mailing Address - Country:US
Mailing Address - Phone:808-206-9371
Mailing Address - Fax:855-270-7441
Practice Address - Street 1:1300 N HOLOPONO ST STE 108
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6946
Practice Address - Country:US
Practice Address - Phone:808-206-9371
Practice Address - Fax:552-707-4418
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
HI38701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator