Healthcare Provider Details

I. General information

NPI: 1154665701
Provider Name (Legal Business Name): EVA ANITA BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 SEAFARE
LAGUNA NIGUEL CA
92677-5985
US

IV. Provider business mailing address

179 SEAFARE
LAGUNA NIGUEL CA
92677-5985
US

V. Phone/Fax

Practice location:
  • Phone: 415-519-0068
  • Fax: 415-519-0068
Mailing address:
  • Phone: 415-519-0068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010779
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS18234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: