Basic Information
| Provider Information | |||||||||
| NPI: | 1184152662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | DWAYNE | ||||||||
| MiddleName: | RAMON | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 W 45TH ST APT 14B | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100363693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175928663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 356 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100114401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122717200 | ||||||||
| FaxNumber: | 2122717225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2017 | ||||||||
| LastUpdateDate: | 05/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0989751 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.