Healthcare Provider Details

I. General information

NPI: 1356237978
Provider Name (Legal Business Name): SAMUEL REUBEN BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 GROVE ST STE 3
WORCESTER MA
01605-3934
US

IV. Provider business mailing address

50 FRANCIS ST
WORCESTER MA
01606-3120
US

V. Phone/Fax

Practice location:
  • Phone: 508-318-7600
  • Fax:
Mailing address:
  • Phone: 508-717-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: