Provider Demographics
NPI:1245730530
Name:BROFFMAN, THOMAS EUGENE
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EUGENE
Last Name:BROFFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:EUGENE
Other - Last Name:BROFFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-0008
Mailing Address - Country:US
Mailing Address - Phone:401-338-5605
Mailing Address - Fax:
Practice Address - Street 1:340 THOMPSON RD.
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570
Practice Address - Country:US
Practice Address - Phone:508-943-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker