Healthcare Provider Details

I. General information

NPI: 1780500629
Provider Name (Legal Business Name): GAYNELLE BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24268 GAZANIA WAY
LAKE ELSINORE CA
92532-2735
US

IV. Provider business mailing address

24268 GAZANIA WAY
LAKE ELSINORE CA
92532-2735
US

V. Phone/Fax

Practice location:
  • Phone: 951-772-5709
  • Fax:
Mailing address:
  • Phone: 951-772-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: