MEDICARE: MONICA DAWN BROWN LMSW, SSW

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	6801085330	MI
2	1041S0200X	School Social Worker	6801085330	MI

General Provider Information

NPI Number	:	1780049502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA DAWN BROWN LMSW, SSW

Provider Business Mailing Address
First Line	:	16191 NORTHLAWN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2949
Country	:	US
Telephone Number	:	313-333-1210
Fax Number	:

Provider Business Practice Location Address
First Line	:	16191 NORTHLAWN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2949
Country	:	US
Telephone Number	:	313-333-1210
Fax Number	:

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

Provider Enumeration Date	:	12/21/2015
Last Update Date	:	12/21/2015

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