Healthcare Provider Details

I. General information

NPI: 1588973614
Provider Name (Legal Business Name): JENNIFER LYNN BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12093 GAYTON RD
HENRICO VA
23238-3401
US

IV. Provider business mailing address

PO BOX 28746
HENRICO VA
23228-8746
US

V. Phone/Fax

Practice location:
  • Phone: 804-404-3177
  • Fax:
Mailing address:
  • Phone: 804-404-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010925
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: