Provider Demographics
NPI:1215002522
Name:SEWALL, BRAD M (MS LCMHC RN)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:M
Last Name:SEWALL
Suffix:
Gender:M
Credentials:MS LCMHC RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 709
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05047-0709
Mailing Address - Country:US
Mailing Address - Phone:802-295-3031
Mailing Address - Fax:802-295-0820
Practice Address - Street 1:49 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:VT
Practice Address - Zip Code:05047
Practice Address - Country:US
Practice Address - Phone:802-295-3031
Practice Address - Fax:802-295-0820
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0067516163W00000X
NH064206-21163W00000X
VT068.0000560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse