Provider Demographics
NPI:1386324804
Name:HOULIHAN, BRENDAN JOHN (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:JOHN
Last Name:HOULIHAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PROSPECT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:TURNERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01376-1382
Mailing Address - Country:US
Mailing Address - Phone:860-841-0061
Mailing Address - Fax:
Practice Address - Street 1:26 PROSPECT ST APT 2
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376-1382
Practice Address - Country:US
Practice Address - Phone:860-841-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT64111041C0700X
MA2280361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical