Basic Information
| Provider Information | |||||||||
| NPI: | 1609394337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | SAMARITAN BEHAVIORAL HEALTH, INC. | ||||||||
| Address2: | 601 EDWIN C. MOSES BLVD. 1ST FLOOR | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454173424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377348333 | ||||||||
| FaxNumber: | 9377344343 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 E MCMILLAN ST | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132213350 | ||||||||
| FaxNumber: | 5134755673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2017 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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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 | 104100000X | S.0013841 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.