MEDICARE: MRS. KEYONDA 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1619029311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEYONDA BROWN LCSW

Provider Business Mailing Address
First Line	:	4968 EUCLID RD STE K
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4968 EUCLID RD STE K
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5833
Country	:	US
Telephone Number	:	757-695-9294
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	02/08/2022

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