1336479369 NPI number — MRS. JOY CARROLL BREWSTER BCBA

Table of content: MRS. JOY CARROLL BREWSTER BCBA (NPI 1336479369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336479369 NPI number — MRS. JOY CARROLL BREWSTER BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREWSTER
Provider First Name:
JOY
Provider Middle Name:
CARROLL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARDS
Provider Other First Name:
JOY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336479369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 677
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLS
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05774-0677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-417-1002
Provider Business Mailing Address Fax Number:
802-783-8631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 SOUTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLS
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-797-5379
Provider Business Practice Location Address Fax Number:
802-783-8631
Provider Enumeration Date:
01/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-01-0417 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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