MEDICARE: MRS. SANDI S 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	105401	TX

General Provider Information

NPI Number	:	1639923253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDI S BROWN LCSW

Provider Business Mailing Address
First Line	:	1803 SANDRA CV
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-6103
Country	:	US
Telephone Number	:	310-210-3559
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 S BELL BLVD STE 201
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-3974
Country	:	US
Telephone Number	:	310-210-3559
Fax Number	:

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

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	04/11/2024

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