Provider Demographics
NPI:1588720668
Name:BRECHER, SALLY (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:
Last Name:BRECHER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2546
Mailing Address - Country:US
Mailing Address - Phone:617-332-9797
Mailing Address - Fax:617-332-9797
Practice Address - Street 1:91 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2546
Practice Address - Country:US
Practice Address - Phone:617-332-9797
Practice Address - Fax:617-332-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1010431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1476OtherBLUE SHIELD