Brian Patterson Southworth, LICSW
Social Worker, Clinical in Burlington, VT. Individual provider (NPI-1).
NPI number1629584875
StatusActive
Last updated in NPPESJun 16, 2018
Details
- NPI
- 1629584875
- Entity type
- Individual (NPI-1)
- Name
- Mr. Brian Patterson Southworth
- Credential
- LICSW
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 26, 2017
- Last updated
- Jun 16, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 0890000563 | VT | Yes |
Practice location
76 Glen RdBurlington, VT 05406-4009
Phone 802-864-7467
Mailing address
76 Glen RdBurlington, VT 05406-4009
Phone 802-864-7467
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