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General NPI Number Information
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NPI Number | 1114327103
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Entity Type | Individual
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Provider Name | KINYA M LUCAS-BROWN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 3247 LOUISE DR # 0
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City | LANSING
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State | IL
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Zip | 60438-3607
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Country | US
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Telephone | 773-530-9492
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Fax |
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Provider Business Mailing Address
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Address Line | 3247 LOUISE DR # 0
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City | LANSING
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State | IL
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Zip | 60438-3607
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Country | US
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Telephone | 773-530-9492
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.026638
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License Number State | IL
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