Provider Demographics
NPI:1881716314
Name:BRUBAKER, TOM H (LCSW)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:H
Last Name:BRUBAKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 OAK ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2028
Mailing Address - Country:US
Mailing Address - Phone:541-386-5744
Mailing Address - Fax:541-296-8002
Practice Address - Street 1:202 OAK ST
Practice Address - Street 2:SUITE 600
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2028
Practice Address - Country:US
Practice Address - Phone:541-386-5744
Practice Address - Fax:541-296-8002
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000THLGPMedicare ID - Type UnspecifiedMEDICARE BILLINB