MEDICARE: CYNTHIA M BROWN PH.D, 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	11312	TX
2	103T00000X	Psychologist	33852	TX

General Provider Information

NPI Number	:	1740292705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA M BROWN PH.D, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 ARBOR PARK
Second Line	:
City	:	BELTON
State	:	TX
Zip	:	76513-8196
Country	:	US
Telephone Number	:	254-933-4100
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	12/03/2021

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