1720787328 NPI number — BRITTNEY LYNN BROSSART MSW, LGSW

Table of content: BRITTNEY LYNN BROSSART MSW, LGSW (NPI 1720787328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720787328 NPI number — BRITTNEY LYNN BROSSART MSW, LGSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROSSART
Provider First Name:
BRITTNEY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LGSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROSSART
Provider Other First Name:
BRITTNEY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LGSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720787328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 N GEORGE ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLES TOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25414-1574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
681-252-1632
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N GEORGE ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLES TOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25414-1574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
681-252-1632
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2023

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: 1041C0700X , with the licence number:  BP00946056 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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