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General NPI Number Information
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NPI Number | 1649494907
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Entity Type | Individual
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Provider Name | MARY INGALLS BROWN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/10/2017
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Provider Practice Location Address
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Address Line | 10992 SAN DIEGO MISSION RD
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City | SAN DIEGO
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State | CA
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Zip | 92108-2444
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Country | US
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Telephone | 619-641-4176
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Fax |
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Provider Business Mailing Address
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Address Line | 10990 SAN DIEGO MISSION RD
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City | SAN DIEGO
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State | CA
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Zip | 92108-2417
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Country | US
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Telephone | 760-722-3977
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCS 19758
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License Number State | CA
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