Healthcare Provider Details

I. General information

NPI: 1124090519
Provider Name (Legal Business Name): BRYAN BROWN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 VILLAGE WAY
NEW BERN NC
28562
US

IV. Provider business mailing address

2800 VILLAGE WAY
NEW BERN NC
28562
US

V. Phone/Fax

Practice location:
  • Phone: 252-637-7300
  • Fax: 252-637-1771
Mailing address:
  • Phone: 252-637-7300
  • Fax: 252-637-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC000303
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: