Provider Demographics
NPI:1699909184
Name:BRAWN, JEFFREY F
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:F
Last Name:BRAWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 COMMERCIAL ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-5964
Mailing Address - Country:US
Mailing Address - Phone:207-470-7090
Mailing Address - Fax:207-470-7094
Practice Address - Street 1:247 COMMERCIAL ST
Practice Address - Street 2:SUITE C
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5964
Practice Address - Country:US
Practice Address - Phone:207-470-7090
Practice Address - Fax:207-470-7094
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC4118101YA0400X
MEMC112421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)