MEDICARE: KIM CLANCY BROWNELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	041454	CT
2	2084P0800X	Psychiatry Physician	041454	CT
3	2084P0804X	Child & Adolescent Psychiatry Physician	041454	CT

General Provider Information

NPI Number	:	1598737314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM CLANCY BROWNELL MD

Provider Business Mailing Address
First Line	:	PO BOX 415933
Second Line	:	HARTFORD HOSPITAL PROFESSIONAL SERVICES
City	:	BOSTON
State	:	MA
Zip	:	02241-5933
Country	:	US
Telephone Number	:	860-545-7602
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 RETREAT AVENUE
Second Line	:	HARTFORD HOSPITAL PSYCHIATRY DEPT
City	:	HARTFORD
State	:	CT
Zip	:	06106-3310
Country	:	US
Telephone Number	:	860-545-7493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	11/14/2013

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