Provider Demographics
NPI:1962414052
Name:BRUBECK, MARCIA ELLEN (MSW)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:ELLEN
Last Name:BRUBECK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1861
Mailing Address - Country:US
Mailing Address - Phone:860-586-8530
Mailing Address - Fax:
Practice Address - Street 1:674 PROSPECT AVE
Practice Address - Street 2:3RR
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4288
Practice Address - Country:US
Practice Address - Phone:860-231-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0044241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical