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NPI Code Detail

MEDICARE: JACQUELINE BROWN LCSW

MEDICARE: JACQUELINE 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
11041C0700XClinical Social Worker34010663IN

General Provider Information

NPI Number : 1386872448
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE BROWN LCSW
Provider Business Mailing Address
First Line : 1708 HIGH ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46613-2633
Country : US
Telephone Number : 574-406-6180
Fax Number : 574-232-9550
Provider Business Practice Location Address
First Line : 1708 HIGH ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46613-2633
Country : US
Telephone Number : 574-406-6180
Fax Number : 574-232-9550
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2009
Last Update Date : 10/04/2023

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Directions to “ JACQUELINE BROWN LCSW” Practice Location

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