Healthcare Provider Details

I. General information

NPI: 1902151871
Provider Name (Legal Business Name): BRANDON JEFFERY LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 WESTMINSTER ST
FITCHBURG MA
01420-4727
US

IV. Provider business mailing address

PO BOX 368
ASHBURNHAM MA
01430-0368
US

V. Phone/Fax

Practice location:
  • Phone: 978-345-0685
  • Fax: 978-342-8495
Mailing address:
  • Phone: 978-245-5139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10006800
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: