1700346608 NPI number — EMILY MARIE BREWSTER MSW, LICSW, LCSW

Table of content: EMILY MARIE BREWSTER MSW, LICSW, LCSW (NPI 1700346608)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700346608 NPI number — EMILY MARIE BREWSTER MSW, LICSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
BREWSTER

Provider First Name:
EMILY

Provider Middle Name:
MARIE

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
MSW, LICSW, LCSW

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700346608

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
02/25/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 955

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
EAGLE POINT

Provider Business Mailing Address State Name:
OR

Provider Business Mailing Address Postal Code:
97524-0955

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
360-800-3873

Provider Business Mailing Address Fax Number:
360-282-0772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 N CENTRAL AVE STE 411

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
MEDFORD

Provider Business Practice Location Address State Name:
OR

Provider Business Practice Location Address Postal Code:
97501-5939

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
360-800-3873

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
03/25/2019

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 1041C0700X , with the licence number: LW61468962 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .