MEDICARE: MISS BRIANNA CLAIRE DACHISEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	123459	MA
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1316314990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRIANNA CLAIRE DACHISEN

Provider Business Mailing Address
First Line	:	1660 SOLDIERS FIELD RD # 1020
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-1108
Country	:	US
Telephone Number	:	908-418-0326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 SOLDIERS FIELD RD # 1020
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-1108
Country	:	US
Telephone Number	:	908-418-0326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2015
Last Update Date	:	08/12/2021

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