=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841768496
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARILYN CORONA BROWN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2018
-----------------------------------------------------
Last Update Date | 01/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 TRAVIS ST STE 10B
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70503-2461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-486-3542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 MICAH EDWARD DR
-----------------------------------------------------
City | MAURICE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70555-3394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-486-3542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 12208
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------