Individual
MR. BRIAN PATTERSON SOUTHWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
76 GLEN RD, BURLINGTON, VT 05406-4009
(802) 864-7467
Mailing address
76 GLEN RD, BURLINGTON, VT 05406-4009
(802) 864-7467
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0890000563
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0890000563
—
VT
05
—
1041C0700X
—
VT
Enumeration date
12/26/2017
Last updated
06/16/2018
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