Provider Demographics
NPI:1306627641
Name:BROWN, HABBIEGALE TASHA (LMSW)
Entity type:Individual
Prefix:
First Name:HABBIEGALE
Middle Name:TASHA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5259
Mailing Address - Country:US
Mailing Address - Phone:475-251-7923
Mailing Address - Fax:
Practice Address - Street 1:100 CORPORATE DR # A201-3
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6343
Practice Address - Country:US
Practice Address - Phone:475-244-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8325104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker