Healthcare Provider Details

I. General information

NPI: 1326159161
Provider Name (Legal Business Name): BENJAMIN BROWN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 NE 3RD ST
MCMINNVILLE OR
97128-4417
US

IV. Provider business mailing address

PO BOX 87
MCMINNVILLE OR
97128-0087
US

V. Phone/Fax

Practice location:
  • Phone: 503-472-2985
  • Fax: 503-883-9165
Mailing address:
  • Phone: 503-472-2985
  • Fax: 503-883-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberOR1731
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: