MEDICARE: BREANA BROWN LCSW

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	1041C0700X	Clinical Social Worker	64853	TX

General Provider Information

NPI Number	:	1144908609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANA BROWN LCSW

Provider Business Mailing Address
First Line	:	4545 BELLAIRE DR S
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1889
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 WEST FWY STE 120
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-7117
Country	:	US
Telephone Number	:	817-657-1115
Fax Number	:

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

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	07/06/2023

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Directions to “ BREANA BROWN LCSW” Practice Location

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