Provider Demographics
NPI:1962552067
Name:MIELE - SOARES, BRENDA (LICSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MIELE - SOARES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:MIELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:12 LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-3048
Mailing Address - Country:US
Mailing Address - Phone:978-562-2322
Mailing Address - Fax:
Practice Address - Street 1:1881 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5410
Practice Address - Country:US
Practice Address - Phone:508-628-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical