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General NPI Number Information
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NPI Number | 1295126894
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Entity Type | Organization
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Legal Business Name | BRANDEIS UNIVERSITY
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 415 SOUTH ST MS061
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City | WALTHAM
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State | MA
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Zip | 02453-2728
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Country | US
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Telephone | 617-921-7009
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Fax |
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Provider Business Mailing Address
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Address Line | 415 SOUTH ST MS 061
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City | WALTHAM
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State | MA
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Zip | 02453-2728
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR OF PCC
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Name | DR. JOY VON STEIGER
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Credential | PHD
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Telephone | 617-875-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 118679
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License Number State | MA
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