MEDICARE: DEYMEONTE BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1508259433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEYMEONTE BROWN

Provider Business Mailing Address
First Line	:	1951 N JONES BLVD APT M202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-0117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6883 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1645
Country	:	US
Telephone Number	:	702-586-1410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2015
Last Update Date	:	03/17/2015

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Directions to “ DEYMEONTE BROWN ” Practice Location

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