Provider Demographics
NPI:1245448356
Name:BROWN, BRUCE A (MSW)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JCT
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3546
Mailing Address - Country:US
Mailing Address - Phone:802-760-9427
Mailing Address - Fax:
Practice Address - Street 1:34 PATCHEN RD
Practice Address - Street 2:
Practice Address - City:S BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5704
Practice Address - Country:US
Practice Address - Phone:802-658-4208
Practice Address - Fax:802-658-2234
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000306101YA0400X
VT089-00005551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN 1840Medicaid
VT0VN 1840Medicaid