Healthcare Provider Details

I. General information

NPI: 1194289215
Provider Name (Legal Business Name): SARAH RICHARDS BROWN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OCEAN AVE
RONKONKOMA NY
11779-6536
US

IV. Provider business mailing address

6 LAURIE PL
WEST SAYVILLE NY
11796-1510
US

V. Phone/Fax

Practice location:
  • Phone: 631-471-7242
  • Fax: 631-676-6934
Mailing address:
  • Phone: 631-678-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number099651
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: