MEDICARE: TWANDA L BROWN LCSW LLC

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	1041C0700X	Clinical Social Worker	44SC05345600	NJ

General Provider Information

NPI Number	:	1700034402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWANDA L BROWN LCSW LLC

Provider Business Mailing Address
First Line	:	2816 MORRIS AVE
Second Line	:	SUITE 28
City	:	UNION
State	:	NJ
Zip	:	07083-4849
Country	:	US
Telephone Number	:	908-688-1616
Fax Number	:	908-688-1162

Provider Business Practice Location Address
First Line	:	2816 MORRIS AVE
Second Line	:	SUITE 28
City	:	UNION
State	:	NJ
Zip	:	07083-4849
Country	:	US
Telephone Number	:	908-688-1616
Fax Number	:	908-688-1162

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	TWANDA L BROWN
Credential	:	LCSW
Telephone Number	:	908-688-1616

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	10/04/2012

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