Provider Demographics
NPI:1386709426
Name:WARD, BRIAN S (MED, MSW)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:WARD
Suffix:
Gender:M
Credentials:MED, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 GREENBANKS HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05828-9611
Mailing Address - Country:US
Mailing Address - Phone:802-684-3636
Mailing Address - Fax:
Practice Address - Street 1:238 GREENBANKS HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VT
Practice Address - Zip Code:05828-9611
Practice Address - Country:US
Practice Address - Phone:802-684-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00006545OtherPSYCHOLOGY
VT00006545Medicaid