Provider Demographics
NPI:1922058122
Name:BRIEF THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:BRIEF THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRONZI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-671-2373
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:SOUTH FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04078-0014
Mailing Address - Country:US
Mailing Address - Phone:207-671-2373
Mailing Address - Fax:207-773-6207
Practice Address - Street 1:95 INDIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4250
Practice Address - Country:US
Practice Address - Phone:207-672-2373
Practice Address - Fax:207-773-6207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC40881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME81669OtherUNITED BEHAVIORAL HEALTH
ME0004665OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER
ME1032675OtherCIGNA
ME7853446OtherAETNA
ME016598OtherANTHEM