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General NPI Number Information
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NPI Number | 1083523625
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Entity Type | Individual
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Provider Name | BRIAN FRUCHTMAN LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 2196 LOWER AFTON RD E APT 112
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City | SAINT PAUL
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State | MN
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Zip | 55119-5034
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Country | US
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Telephone | 612-389-6865
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Fax |
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Provider Business Mailing Address
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Address Line | 2196 LOWER AFTON RD E APT 112
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City | SAINT PAUL
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State | MN
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Zip | 55119-5034
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Country | US
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Telephone | 612-475-2698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 118316
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License Number State | NY
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