Provider Demographics
NPI:1225331069
Name:BROWN, ROYAL GUY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROYAL
Middle Name:GUY
Last Name:BROWN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NEW KARNER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3854
Mailing Address - Country:US
Mailing Address - Phone:518-431-1650
Mailing Address - Fax:518-626-5407
Practice Address - Street 1:401 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3854
Practice Address - Country:US
Practice Address - Phone:518-431-1650
Practice Address - Fax:518-447-0429
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078148-1104100000X
NY079961-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker