Basic Information
| Provider Information | |||||||||
| NPI: | 1780247528 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068104710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037434412 | ||||||||
| FaxNumber: | 2037381188 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 MAIN ST N STE 2F | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067982966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604830796 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2019 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 10446 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 008103980 | 05 | CT | MEDICAID |