Provider Demographics
NPI:1508114265
Name:BRUGMAN, STUART THEODORE
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:THEODORE
Last Name:BRUGMAN
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 1:297 NAHANT RD APT 1
Mailing Address - Street 2:
Mailing Address - City:NAHANT
Mailing Address - State:MA
Mailing Address - Zip Code:01908-1474
Mailing Address - Country:US
Mailing Address - Phone:917-541-2541
Mailing Address - Fax:
Practice Address - Street 1:297 NAHANT RD APT 1
Practice Address - Street 2:
Practice Address - City:NAHANT
Practice Address - State:MA
Practice Address - Zip Code:01908-1474
Practice Address - Country:US
Practice Address - Phone:917-541-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013895101YM0800X
101YM0800X
MALMHC13150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health