=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750556551
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTHA K. BROWN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2008
-----------------------------------------------------
Last Update Date | 01/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 JOHN ST
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47713-2733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-492-8330
-----------------------------------------------------
Fax | 812-492-8333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 MULBERRY ST
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47713-1230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-436-4232
-----------------------------------------------------
Fax | 812-422-7558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 34002958A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------