Healthcare Provider Details

I. General information

NPI: 1093209694
Provider Name (Legal Business Name): MEGAN RACHELLE BROWN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 DOMINGO RD NE
ALBUQUERQUE NM
87108-1610
US

IV. Provider business mailing address

1119 BETTS ST NE
ALBUQUERQUE NM
87112-5415
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-5295
  • Fax: 505-268-9967
Mailing address:
  • Phone: 505-463-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0174
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: