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General NPI Number Information
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NPI Number | 1962159582
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Entity Type | Individual
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Provider Name | TERESA JEAN BROWN LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/03/2022
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Last Update Date | 10/15/2023
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Provider Practice Location Address
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Address Line | 570 MEMORIAL CIR STE 200
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5002
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Country | US
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Telephone | 386-451-2346
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Fax | 386-317-0664
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Provider Business Mailing Address
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Address Line | 570 MEMORIAL CIR STE 200
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5063
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Country | US
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Telephone | 386-944-9813
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Fax | 386-317-0664
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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 | 22125
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License Number State | FL
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