Provider Demographics
NPI:1902874621
Name:DACEY, BRIAN MICHAEL (LICSW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:DACEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WOODMONT AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2037
Mailing Address - Country:US
Mailing Address - Phone:978-372-0575
Mailing Address - Fax:
Practice Address - Street 1:38 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-6230
Practice Address - Country:US
Practice Address - Phone:978-372-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1003101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADAP02389Medicare ID - Type Unspecified
P02389Medicare PIN