Healthcare Provider Details

I. General information

NPI: 1639842032
Provider Name (Legal Business Name): AMONI BROWN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD
LANSING MI
48910-6818
US

IV. Provider business mailing address

1046 MAPLETREE CT APT 7
LANSING MI
48917-2010
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-5263
  • Fax:
Mailing address:
  • Phone: 517-894-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851110552
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: