Provider Demographics
NPI:1760463871
Name:BRODEUR, ALFRED L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:L
Last Name:BRODEUR
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 1:83 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6804
Mailing Address - Country:US
Mailing Address - Phone:207-784-3907
Mailing Address - Fax:
Practice Address - Street 1:81 MAIN ST BOX 16
Practice Address - Street 2:SUITE 102
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5883
Practice Address - Country:US
Practice Address - Phone:207-777-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME461514000OtherMAGELLAN
ME017270OtherBCBS
ME017270OtherBCBS