Basic Information
| Provider Information | |||||||||
| NPI: | 1558532523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROD | ||||||||
| FirstName: | STEVE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 MAIN STREET | ||||||||
| Address2: | SUITE #2 | ||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003665302 | ||||||||
| FaxNumber: | 2078736612 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 MAIN ST | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | WILTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078725300 | ||||||||
| FaxNumber: | 2076453277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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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 | LC688 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.