Healthcare Provider Details

I. General information

NPI: 1558317222
Provider Name (Legal Business Name): MARY PHYLLIS BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N RITTER AVE
INDIANAPOLIS IN
46219-3027
US

IV. Provider business mailing address

6950 HILLSDALE CT
INDIANAPOLIS IN
46250-2040
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-2560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004081A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number34004081A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: