MEDICARE: LISA BETH BROWN PHD, LCSW, MED

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	094382	NY

General Provider Information

NPI Number	:	1720639909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BETH BROWN PHD, LCSW, MED

Provider Business Mailing Address
First Line	:	1289 LEXINGTON AVE APT 16A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-2230
Country	:	US
Telephone Number	:	516-639-2072
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 PLAZA ST E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-5025
Country	:	US
Telephone Number	:	516-639-2072
Fax Number	:

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

Provider Enumeration Date	:	09/27/2019
Last Update Date	:	04/16/2025

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