Healthcare Provider Details

I. General information

NPI: 1538681978
Provider Name (Legal Business Name): MARVIN LAVERNE BROWN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 E 149TH ST
BRONX NY
10451-5625
US

IV. Provider business mailing address

65 COURT ST
BROOKLYN NY
11201-4916
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-2698
  • Fax: 718-769-2317
Mailing address:
  • Phone: 310-850-6662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1070783161
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089842
License Number StateNY

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: