Healthcare Provider Details

I. General information

NPI: 1245195247
Provider Name (Legal Business Name): EMILI BROWN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 VISTA GRANDE DR NW UNIT 12 UNIT 12
ALBUQUERQUE NM
87120-1040
US

IV. Provider business mailing address

2700 VISTA GRANDE DR NW UNIT 12
ALBUQUERQUE NM
87120-1040
US

V. Phone/Fax

Practice location:
  • Phone: 520-982-3438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: