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General NPI Number Information
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NPI Number | 1922058122
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Entity Type | Organization
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Legal Business Name | BRIEF THERAPY ASSOCIATES
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 95 INDIA ST
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City | PORTLAND
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State | ME
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Zip | 04101-4250
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Country | US
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Telephone | 207-672-2373
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Fax | 207-773-6207
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Provider Business Mailing Address
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Address Line | PO BOX 14
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City | SOUTH FREEPORT
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State | ME
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Zip | 04078-0014
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Country | US
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Telephone | 207-671-2373
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Fax | 207-773-6207
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARILYN T. BRONZI
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Credential | LCSW
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Telephone | 207-671-2373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC4088
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License Number State | ME
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