Provider Demographics
NPI:1134209836
Name:MUNSON, BRENT J (LMFT)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:J
Last Name:MUNSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9543
Mailing Address - Country:US
Mailing Address - Phone:860-966-1461
Mailing Address - Fax:
Practice Address - Street 1:113 KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9543
Practice Address - Country:US
Practice Address - Phone:860-966-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist