Provider Demographics
NPI:1043497217
Name:LABRECK, TODD WILLIAM (LICSW)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:WILLIAM
Last Name:LABRECK
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:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:MANOMET
Mailing Address - State:MA
Mailing Address - Zip Code:02345-0254
Mailing Address - Country:US
Mailing Address - Phone:508-846-6321
Mailing Address - Fax:
Practice Address - Street 1:1 PEARL ST STE 2300
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2868
Practice Address - Country:US
Practice Address - Phone:508-846-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1112991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18467OtherBLUE CROSS BLUE SHIELD
MAP22834OtherMEDICARE
MAP22834OtherFALLON
MA334607OtherTRI-CARE