Provider Demographics
NPI:1144553710
Name:BREWER, JOSEPH DONALD (BS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DONALD
Last Name:BREWER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S CATALINA ST
Mailing Address - Street 2:APT. 117
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-2028
Mailing Address - Country:US
Mailing Address - Phone:213-999-1555
Mailing Address - Fax:
Practice Address - Street 1:555 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-1612
Practice Address - Country:US
Practice Address - Phone:310-352-6422
Practice Address - Fax:310-352-6480
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)