MEDICARE: NICOLE N. 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	075715	NY

General Provider Information

NPI Number	:	1700953171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE N. BROWN LCSW

Provider Business Mailing Address
First Line	:	1416 SWEET HOME RD
Second Line	:	SUITE 3
City	:	AMHERST
State	:	NY
Zip	:	14228-2784
Country	:	US
Telephone Number	:	917-674-6742
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 SWEET HOME RD
Second Line	:	SUITE 3
City	:	AMHERST
State	:	NY
Zip	:	14228-2784
Country	:	US
Telephone Number	:	917-674-6742
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/21/2015

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