Provider Demographics
NPI:1295045268
Name:BROWN, RISHEEN (LICSW)
Entity Type:Individual
Prefix:
First Name:RISHEEN
Middle Name:
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 1:542 MASSACHUSETTS AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1439
Mailing Address - Country:US
Mailing Address - Phone:978-264-3500
Mailing Address - Fax:
Practice Address - Street 1:729 BOYLSTON ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2639
Practice Address - Country:US
Practice Address - Phone:917-300-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0819981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1003991019OtherAGENCY'S NPI #
NY00745088OtherAGENCY'S MEDICAID MMIS #