Provider Demographics
NPI:1386755841
Name:BROPHY, GERALDINE MARIE (LICSW)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:MARIE
Last Name:BROPHY
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 1:25 ROCHDALE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1205
Mailing Address - Country:US
Mailing Address - Phone:508-864-3379
Mailing Address - Fax:508-987-2598
Practice Address - Street 1:304 MAIN ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01540-2386
Practice Address - Country:US
Practice Address - Phone:508-864-3379
Practice Address - Fax:508-987-2598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA352710OtherMAGELLAN
MAPO7616OtherBLUE CROSS BLUE SHIELD
MA352710OtherMAGELLAN