Provider Demographics
NPI:1164577722
Name:BROWN, LISA A (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-1329
Mailing Address - Country:US
Mailing Address - Phone:978-664-2566
Mailing Address - Fax:
Practice Address - Street 1:324 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-1329
Practice Address - Country:US
Practice Address - Phone:978-664-2566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10216951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical