MEDICARE: RISA BROWN LMSW

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	2023020130	MO

General Provider Information

NPI Number	:	1942081450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RISA BROWN LMSW

Provider Business Mailing Address
First Line	:	7136 WASHINGTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-4312
Country	:	US
Telephone Number	:	314-458-6826
Fax Number	:

Provider Business Practice Location Address
First Line	:	8301 MARYLAND AVE STE 310
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3660
Country	:	US
Telephone Number	:	314-458-6826
Fax Number	:

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

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	10/10/2023

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