Healthcare Provider Details

I. General information

NPI: 1205774247
Provider Name (Legal Business Name): JENARD BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 9TH ST NE
WASHINGTON DC
20017-3506
US

IV. Provider business mailing address

3350 9TH ST NE
WASHINGTON DC
20017-3506
US

V. Phone/Fax

Practice location:
  • Phone: 919-309-5910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200004301
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: