Healthcare Provider Details

I. General information

NPI: 1669360046
Provider Name (Legal Business Name): LILY JANE BROWN MFA, MSW CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N PROVIDENCE RD
MEDIA PA
19063-3056
US

IV. Provider business mailing address

2406 E GORDON ST
PHILADELPHIA PA
19125-2908
US

V. Phone/Fax

Practice location:
  • Phone: 484-440-9416
  • Fax: 484-551-0474
Mailing address:
  • Phone: 610-608-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

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: