Provider Demographics
NPI:1285646604
Name:BREWER, M JANE (MSW)
Entity Type:Individual
Prefix:MS
First Name:M JANE
Middle Name:
Last Name:BREWER
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 1:804 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5364
Mailing Address - Country:US
Mailing Address - Phone:504-832-0602
Mailing Address - Fax:504-828-8814
Practice Address - Street 1:804 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5364
Practice Address - Country:US
Practice Address - Phone:504-832-0602
Practice Address - Fax:504-828-8814
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S431Medicare ID - Type Unspecified