Healthcare Provider Details

I. General information

NPI: 1841573698
Provider Name (Legal Business Name): PATRICIA BROUWER LCDP; LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 ATWOOD AVE
JOHNSTON RI
02919-3223
US

IV. Provider business mailing address

1516 ATWOOD AVE
JOHNSTON RI
02919-3223
US

V. Phone/Fax

Practice location:
  • Phone: 401-553-1000
  • Fax: 401-553-1143
Mailing address:
  • Phone: 401-553-1000
  • Fax: 401-553-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00714
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00338
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: