MEDICARE: ROSCHNELL M BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	KY1760	OTHER	KY	LCSW

General Provider Information

NPI Number	:	1093878621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSCHNELL M BROWN

Provider Business Mailing Address
First Line	:	425 BROADWAY
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 BROADWAY ST
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-0713
Country	:	US
Telephone Number	:	270-442-7121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/21/2020

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Directions to “ ROSCHNELL M BROWN ” Practice Location

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