Healthcare Provider Details

I. General information

NPI: 1043552995
Provider Name (Legal Business Name): NICHOLA K BROWN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 K ST NE
WASHINGTON DC
20002-4216
US

IV. Provider business mailing address

102 MICHIGAN AVE NE B-13
WASHINGTON DC
20017-1027
US

V. Phone/Fax

Practice location:
  • Phone: 202-442-4946
  • Fax:
Mailing address:
  • Phone: 240-997-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079542
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: