Healthcare Provider Details

I. General information

NPI: 1821279670
Provider Name (Legal Business Name): NANCYANN BRASSARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY BRASSARD

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WINTHROP ST
NEW BRITAIN CT
06052-1728
US

IV. Provider business mailing address

5 HART ST
NEW BRITAIN CT
06052-1701
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-8192
  • Fax:
Mailing address:
  • Phone: 860-229-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005047
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: