Provider Demographics
NPI:1639387749
Name:BRUTUS, MARTIN (MPHIL,PHD,MA)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:BRUTUS
Suffix:
Gender:M
Credentials:MPHIL,PHD,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 ORCHARD FARM LN
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-9059
Mailing Address - Country:US
Mailing Address - Phone:802-730-3866
Mailing Address - Fax:802-888-4362
Practice Address - Street 1:153 ORCHARD FARM LN
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655-9059
Practice Address - Country:US
Practice Address - Phone:802-888-4362
Practice Address - Fax:802-888-4362
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT068-0000457OtherMENTAL HEALTH COUNSELOR