Basic Information
| Provider Information | |||||||||
| NPI: | 1588973614 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19254 ROGERS CLARK BLVD | ||||||||
| Address2: | |||||||||
| City: | RUTHER GLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225464010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8046339997 | ||||||||
| FaxNumber: | 5403713753 | ||||||||
| Practice Location | |||||||||
| Address1: | 19254 ROGERS CLARK BLVD | ||||||||
| Address2: | |||||||||
| City: | RUTHER GLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8046339997 | ||||||||
| FaxNumber: | 5403713753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2010 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904010925 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.