Individual
LACEY A BRANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
77-79 BISHOP STREET, WATERBURY, CT 06710-1610
(203) 695-4917
Mailing address
77 BISHOP ST, WATERBURY, CT 06704-3306
(203) 695-4917
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1113
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235918
—
CT
Enumeration date
11/23/2009
Last updated
07/18/2016
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