Basic Information
| Provider Information | |||||||||
| NPI: | 1770964355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | CENTELL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4942 GAWAIN DR | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701273224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042357592 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2626 CHARLES DR | ||||||||
| Address2: | |||||||||
| City: | CHALMETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700433779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042784006 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2015 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | 13383 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | 13383 | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 0 | 05 | LA | MEDICAID |