Provider Demographics
NPI:1316006943
Name:BROUSELL, RICHARD PAUL (LPCMH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PAUL
Last Name:BROUSELL
Suffix:
Gender:M
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 FOULK WOODS RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3636
Mailing Address - Country:US
Mailing Address - Phone:302-475-6077
Mailing Address - Fax:302-475-1641
Practice Address - Street 1:2505 FOULK WOODS RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3636
Practice Address - Country:US
Practice Address - Phone:302-475-6077
Practice Address - Fax:302-475-1641
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001129357Medicaid