Provider Demographics
NPI:1336479369
Name:BREWSTER, JOY CARROLL (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:CARROLL
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:VT
Mailing Address - Zip Code:05774-0677
Mailing Address - Country:US
Mailing Address - Phone:802-417-1002
Mailing Address - Fax:802-783-8631
Practice Address - Street 1:85 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:VT
Practice Address - Zip Code:05774
Practice Address - Country:US
Practice Address - Phone:845-797-5379
Practice Address - Fax:802-783-8631
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-01-0417103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst