1689796401 NPI number — MRS. ERIN KATHLEEN BRAZILL LCSW, ATR- BC

Table of content: MRS. ERIN KATHLEEN BRAZILL LCSW, ATR- BC (NPI 1689796401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689796401 NPI number — MRS. ERIN KATHLEEN BRAZILL LCSW, ATR- BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAZILL
Provider First Name:
ERIN
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, ATR- BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGOVERN
Provider Other First Name:
ERIN
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689796401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1159 PITTSFORD VICTOR RD STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14534-3839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-622-1909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1159 PITTSFORD VICTOR RD STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14534-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-622-1909
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4012 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: I.1100072 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 149012478 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 088837 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1184775413 . This is a "ORGANIZATIONAL NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".