Individual
BRENDEN IZAYJAH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
121 STATE ST STE 100, SPRINGFIELD, MA 01103-1986
(413) 301-7797
(413) 301-7896
Mailing address
125 LIBERTY ST STE 100, SPRINGFIELD, MA 01103-1109
(413) 301-7797
(413) 301-7896
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/24/2023
Last updated
04/24/2023
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