Provider Demographics
NPI:1235139502
Name:BROWNE, SUSAN (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BROWNE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 KERCHEVAL AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3629
Mailing Address - Country:US
Mailing Address - Phone:313-882-1430
Mailing Address - Fax:
Practice Address - Street 1:131 KERCHEVAL AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3629
Practice Address - Country:US
Practice Address - Phone:313-882-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010007121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80-0896360OtherBLUE CROSS BLUE SHIELD
MI0P03320Medicare ID - Type Unspecified