MEDICARE: LIAM T 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

General Provider Information

NPI Number	:	1194240887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIAM T BROWN LCSW

Provider Business Mailing Address
First Line	:	3565 W MCLEAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3620
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3021A N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6612
Country	:	US
Telephone Number	:	203-293-0299
Fax Number	:

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

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	08/03/2017

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