Provider Demographics
NPI:1609816263
Name:BROWN, WILLIAM G (LICSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:BROWN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:108 APPLETON ST
Mailing Address - Street 2:APT A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:617-461-4065
Mailing Address - Fax:
Practice Address - Street 1:607 BOYLSTON ST SECOND FLOOR
Practice Address - Street 2:C/O RASI ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3604
Practice Address - Country:US
Practice Address - Phone:617-461-4065
Practice Address - Fax:617-266-2070
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10319011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABRP21336Medicare PIN