Provider Demographics
NPI:1306395405
Name:BREZIL, GEDEON (LCSW)
Entity Type:Individual
Prefix:
First Name:GEDEON
Middle Name:
Last Name:BREZIL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1497
Mailing Address - Country:US
Mailing Address - Phone:508-496-7764
Mailing Address - Fax:
Practice Address - Street 1:94 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2123
Practice Address - Country:US
Practice Address - Phone:508-947-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2192361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical