Healthcare Provider Details

I. General information

NPI: 1316475064
Provider Name (Legal Business Name): NICHOLAS M. BRISBON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 GRAND ARMY HWY
SWANSEA MA
02777-4212
US

IV. Provider business mailing address

1241 GRAND ARMY HWY
SWANSEA MA
02777-4212
US

V. Phone/Fax

Practice location:
  • Phone: 508-642-3884
  • Fax:
Mailing address:
  • Phone: 508-642-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11231
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01947
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: