Provider Demographics
NPI:1265639124
Name:BROWN, NANCY L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
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 1:1051 BEACON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5685
Mailing Address - Country:US
Mailing Address - Phone:617-281-0847
Mailing Address - Fax:
Practice Address - Street 1:1051 BEACON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5685
Practice Address - Country:US
Practice Address - Phone:617-281-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABR-P23850Medicare ID - Type UnspecifiedMEDICARE