Provider Demographics
NPI:1841332145
Name:BROWN, EMANUEL BONIFALE (MED CASS)
Entity type:Individual
Prefix:MR
First Name:EMANUEL
Middle Name:BONIFALE
Last Name:BROWN
Suffix:
Gender:M
Credentials:MED CASS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90294
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01139
Mailing Address - Country:US
Mailing Address - Phone:413-747-9070
Mailing Address - Fax:413-747-9500
Practice Address - Street 1:227 MILL STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108
Practice Address - Country:US
Practice Address - Phone:413-747-9070
Practice Address - Fax:413-747-9500
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA671101YA0400X
MA1826101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health