Healthcare Provider Details

I. General information

NPI: 1932190592
Provider Name (Legal Business Name): LAURA R BRAND PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WASHINGTON ST
FRANKLIN MA
02038-3300
US

IV. Provider business mailing address

620 WASHINGTON ST
FRANKLIN MA
02038-3300
US

V. Phone/Fax

Practice location:
  • Phone: 508-553-9145
  • Fax: 508-520-3167
Mailing address:
  • Phone: 508-553-9145
  • Fax: 508-520-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPA790
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number790
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: