Basic Information
| Provider Information | |||||||||
| NPI: | 1801966734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWNE | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 548 | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535230548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084234700 | ||||||||
| FaxNumber: | 6084237751 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 EAST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084234700 | ||||||||
| FaxNumber: | 6084237751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 3035123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 39206600 | 05 | WI | MEDICAID |