Healthcare Provider Details

I. General information

NPI: 1457860314
Provider Name (Legal Business Name): MAYA BROWN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W BROADWAY AVE STE 110
MINNEAPOLIS MN
55411-2531
US

IV. Provider business mailing address

1011 W BROADWAY AVE STE 110
MINNEAPOLIS MN
55411-2531
US

V. Phone/Fax

Practice location:
  • Phone: 612-886-4218
  • Fax: 800-640-5242
Mailing address:
  • Phone: 612-886-4218
  • Fax: 800-640-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: