Healthcare Provider Details

I. General information

NPI: 1386302727
Provider Name (Legal Business Name): LORENZO SHANNON BROWN LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 ALLENWOOD DR
PLAINFIELD NJ
07060-2807
US

IV. Provider business mailing address

1074 ALLENWOOD DR
PLAINFIELD NJ
07060-2807
US

V. Phone/Fax

Practice location:
  • Phone: 908-346-2227
  • Fax:
Mailing address:
  • Phone: 908-346-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number44SL06723700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: