Healthcare Provider Details

I. General information

NPI: 1063882611
Provider Name (Legal Business Name): NAOMI BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 UNIVERSITY DR STE 100
FAIRFAX VA
22030-3400
US

IV. Provider business mailing address

4031 UNIVERSITY DR STE 100
FAIRFAX VA
22030-3400
US

V. Phone/Fax

Practice location:
  • Phone: 703-278-2832
  • Fax:
Mailing address:
  • Phone: 703-278-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLG50081295
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904010150
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: