Provider Demographics
NPI:1285050583
Name:THOMEN-BROWN, CAMILLE (LICSW)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:THOMEN-BROWN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LITTLE EAGLE BAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2783
Mailing Address - Country:US
Mailing Address - Phone:513-295-2121
Mailing Address - Fax:
Practice Address - Street 1:32 LITTLE EAGLE BAY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-2783
Practice Address - Country:US
Practice Address - Phone:513-295-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219658104100000X
VT089.01286351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker