Healthcare Provider Details

I. General information

NPI: 1053527192
Provider Name (Legal Business Name): LUCILLE BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E BROAD ST
BETHLEHEM PA
18018-6311
US

IV. Provider business mailing address

2006 AREY LN
WHITEHALL PA
18052-3981
US

V. Phone/Fax

Practice location:
  • Phone: 610-861-8779
  • Fax: 610-861-4677
Mailing address:
  • Phone: 610-266-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00572700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016551
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: