Basic Information
| Provider Information | |||||||||
| NPI: | 1770885444 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 PROSPECT PL | ||||||||
| Address2: | 9M | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112384266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474155955 | ||||||||
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| Practice Location | |||||||||
| Address1: | 598 BROADWAY | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100123206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129669537 | ||||||||
| FaxNumber: | 2125845450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2010 | ||||||||
| LastUpdateDate: | 12/01/2010 | ||||||||
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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 | 081835 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.