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General NPI Number Information
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NPI Number | 1962414052
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Entity Type | Individual
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Provider Name | MARCIA ELLEN BRUBECK MSW
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Gender | Female
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 674 PROSPECT AVE 3RR
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City | HARTFORD
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State | CT
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Zip | 06105-4288
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Country | US
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Telephone | 860-231-1997
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Fax |
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Provider Business Mailing Address
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Address Line | 114 SOMERSET ST
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1861
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Country | US
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Telephone | 860-586-8530
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 004424
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License Number State | CT
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