Basic Information
| Provider Information | |||||||||
| NPI: | 1649996687 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM CHRISTOPHER BROWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 98 QUASSUK RD | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067982901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8587616851 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 MAIN ST N STE 2F | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067982966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604830796 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2022 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | VAIL | ||||||||
| AuthorizedOfficialFirstName: | LUCY | ||||||||
| AuthorizedOfficialMiddleName: | IRENE | ||||||||
| AuthorizedOfficialTitleorPosition: | COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8587616851 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.