Provider Demographics
NPI:1154052298
Name:JOELLE BROHEN LICSW PLLC
Entity Type:Organization
Organization Name:JOELLE BROHEN LICSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHEYENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-773-0888
Mailing Address - Street 1:66 COUNTY HOME RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:CT
Mailing Address - Zip Code:06277-2840
Mailing Address - Country:US
Mailing Address - Phone:860-481-2887
Mailing Address - Fax:
Practice Address - Street 1:66 COUNTY HOME RD
Practice Address - Street 2:
Practice Address - City:THOMPSON
Practice Address - State:CT
Practice Address - Zip Code:06277-2840
Practice Address - Country:US
Practice Address - Phone:860-481-2887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health