Provider Demographics
NPI:1215393129
Name:BROWN, EDWARD (LMSW)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 CARTER ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3227
Mailing Address - Country:US
Mailing Address - Phone:318-336-4700
Mailing Address - Fax:318-336-4777
Practice Address - Street 1:1109 CARTER ST
Practice Address - Street 2:SUITE 10
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3227
Practice Address - Country:US
Practice Address - Phone:318-336-4700
Practice Address - Fax:318-336-4777
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 171M00000X
LA8337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1561444Medicaid