Healthcare Provider Details

I. General information

NPI: 1265009807
Provider Name (Legal Business Name): EMILY D BRASSARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 ROUTE 72 SUITE 300
MOUNT LAUREL NJ
08054-0805
US

IV. Provider business mailing address

9 SAWYER LN
SAUGERTIES NY
12477-4252
US

V. Phone/Fax

Practice location:
  • Phone: 856-372-0994
  • Fax: 856-861-1364
Mailing address:
  • Phone: 845-417-7884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089691-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier084390-01
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLMSW LICENSE
# 2
Identifier089691-01
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLCSW LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: