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: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19254 ROGERS CLARK BLVD
RUTHER GLEN VA
22546
US

IV. Provider business mailing address

19254 ROGERS CLARK BLVD
RUTHER GLEN VA
22546-4010
US

V. Phone/Fax

Practice location:
  • Phone: 804-633-9997
  • Fax: 540-371-3753
Mailing address:
  • Phone: 804-633-9997
  • Fax: 540-371-3753

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: