=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992174999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUE BROWN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2015
-----------------------------------------------------
Last Update Date | 02/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 W 40TH ST STE 358
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21211-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-350-0813
-----------------------------------------------------
Fax | 484-805-7166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 W 40TH ST STE 358
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21211-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-350-0813
-----------------------------------------------------
Fax | 484-805-7166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUSAN BROWN
-----------------------------------------------------
Credential | LCSW-C
-----------------------------------------------------
Telephone | 443-350-0813
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 13617
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------