Provider Demographics
NPI:1558532523
Name:BROD, STEVE R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:R
Last Name:BROD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAIN STREET
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:800-366-5302
Mailing Address - Fax:207-873-6612
Practice Address - Street 1:280 MAIN ST
Practice Address - Street 2:SUITE 390
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294
Practice Address - Country:US
Practice Address - Phone:207-872-5300
Practice Address - Fax:207-645-3277
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health