Healthcare Provider Details

I. General information

NPI: 1811092653
Provider Name (Legal Business Name): NAN BROWN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MAIN ST STE 100
WARWICK NY
10990-1347
US

IV. Provider business mailing address

PO BOX 80
LINCOLNDALE NY
10540
US

V. Phone/Fax

Practice location:
  • Phone: 914-248-6833
  • Fax: 845-258-4611
Mailing address:
  • Phone: 914-248-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSWPR0223241
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00010400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR022324
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: