Provider Demographics
NPI:1043321086
Name:BROWN, ELLEN J (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-4401
Mailing Address - Country:US
Mailing Address - Phone:207-837-9350
Mailing Address - Fax:
Practice Address - Street 1:243 HIGH ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6603
Practice Address - Country:US
Practice Address - Phone:207-837-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC102251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME100540OtherANTHEM BLUE SHIELD
ME100540OtherANTHEM BLUE SHIELD