Healthcare Provider Details

I. General information

NPI: 1851497374
Provider Name (Legal Business Name): SHERRI SUSAN BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 BLUE RIDGE RD SUITE 200
RALEIGH NC
27612-4650
US

IV. Provider business mailing address

3010 BARRYMORE ST #105
RALEIGH NC
27603-3374
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-4981
  • Fax: 919-782-2474
Mailing address:
  • Phone: 919-781-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004159
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: