Provider Demographics
NPI:1518778760
Name:BROWN, SAMUEL E (MACMHC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:MACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2528
Mailing Address - Country:US
Mailing Address - Phone:978-290-7177
Mailing Address - Fax:
Practice Address - Street 1:645 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2528
Practice Address - Country:US
Practice Address - Phone:978-290-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health