MEDICARE: WAYNE PETER BROWN L.C.S.W.

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	SW8210	FL

General Provider Information

NPI Number	:	1194939579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE PETER BROWN L.C.S.W.

Provider Business Mailing Address
First Line	:	1467 NE 56TH ST
Second Line	:	SUITE 2
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33334-6111
Country	:	US
Telephone Number	:	954-536-8257
Fax Number	:	954-963-7169

Provider Business Practice Location Address
First Line	:	1467 NE 56TH ST
Second Line	:	SUITE 2
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33334-6111
Country	:	US
Telephone Number	:	954-536-8257
Fax Number	:	954-963-7169

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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