Provider Demographics
NPI:1336251735
Name:BICKFORD, BRIAN
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:BICKFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LOVELL ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-2575
Mailing Address - Country:US
Mailing Address - Phone:508-757-5927
Mailing Address - Fax:
Practice Address - Street 1:110 ERDMAN WAY
Practice Address - Street 2:COMMUNITY HEALTHLINK LIPTON CENTER
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1819
Practice Address - Country:US
Practice Address - Phone:978-537-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health