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Individual
MR. JERROLD BRESHIN
Active
Individual
MR. JERROLD BRESHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
PR041299-1
NY
1041C0700X
Clinical Social Worker
Primary
SW107504
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1038700
TRICARE
MA
01
—
1854941
MASS HEALTH
MA
01
—
1896024
MBHP
MA
05
—
1896024
—
MA
01
—
2041870
HCVM
MA
01
—
P07062
BCBSMA
MA
Enumeration date
07/18/2006
Last updated
07/08/2007
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