MEDICARE: STEVEN RALLIS BROWN L.C.S.W.

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	LCSW-13806	AZ
2	1041C0700X	Clinical Social Worker	345611-3501	UT

General Provider Information

NPI Number	:	1952731176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN RALLIS BROWN L.C.S.W.

Provider Business Mailing Address
First Line	:	201 W GUADALUPE RD STE 314
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-3319
Country	:	US
Telephone Number	:	480-632-1345
Fax Number	:	480-632-1354

Provider Business Practice Location Address
First Line	:	201 W GUADALUPE RD STE 314
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-3319
Country	:	US
Telephone Number	:	480-632-1345
Fax Number	:	480-632-1354

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

Provider Enumeration Date	:	11/25/2013
Last Update Date	:	11/25/2013

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