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General NPI Number Information
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NPI Number | 1124476916
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Entity Type | Individual
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Provider Name | WALTER BROWNSWORD III MA, LADC, CS
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Gender | Male
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 112 JERICHO ROAD
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City | RICHMOND
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State | VT
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Zip | 05477-0361
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Country | US
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Telephone | 802-922-7570
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Fax |
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Provider Business Mailing Address
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Address Line | 112 JERICHO ROAD PO BOX 361 (IF USPS)
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City | RICHMOND
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State | VT
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Zip | 05477-0361
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Country | US
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Telephone | 802-922-7570
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000030
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 694
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License Number State | VT
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