Healthcare Provider Details

I. General information

NPI: 1386709426
Provider Name (Legal Business Name): BRIAN S WARD M.ED., M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 GREENBANKS HOLLOW RD
DANVILLE VT
05828-9611
US

IV. Provider business mailing address

238 GREENBANKS HOLLOW RD
DANVILLE VT
05828-9611
US

V. Phone/Fax

Practice location:
  • Phone: 802-684-3636
  • Fax:
Mailing address:
  • Phone: 802-684-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: