Provider Demographics
NPI:1295019479
Name:BROWN, TIMOTHY (MSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 WEST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4536
Mailing Address - Country:US
Mailing Address - Phone:510-874-3715
Mailing Address - Fax:510-874-3719
Practice Address - Street 1:2850 WEST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-4536
Practice Address - Country:US
Practice Address - Phone:510-874-3715
Practice Address - Fax:510-874-3719
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 23187390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program