Basic Information
| Provider Information | |||||||||
| NPI: | 1336251735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BICKFORD | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 LOVELL ST APT 3L | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016032575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087575927 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 ERDMAN WAY | ||||||||
| Address2: | COMMUNITY HEALTHLINK LIPTON CENTER | ||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014531819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785370956 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.