Provider Demographics
NPI:1790294650
Name:BROTHERS, KEVIN TODD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:TODD
Last Name:BROTHERS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1118 BEDFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1303
Mailing Address - Country:US
Mailing Address - Phone:718-875-7411
Mailing Address - Fax:718-643-1840
Practice Address - Street 1:1118 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1303
Practice Address - Country:US
Practice Address - Phone:718-875-7411
Practice Address - Fax:718-643-1840
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY097605-1104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker