Healthcare Provider Details

I. General information

NPI: 1588581797
Provider Name (Legal Business Name): LARISSA MONAE BROWN PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 YORK ST
WARREN AR
71671-3218
US

IV. Provider business mailing address

1901 W 40TH AVE APT 313
PINE BLUFF AR
71603-6906
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-9955
  • Fax: 870-226-9972
Mailing address:
  • Phone: 773-619-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: