Provider Demographics
NPI:1326159161
Name:BROWN, BENJAMIN (MSW)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
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:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-0087
Mailing Address - Country:US
Mailing Address - Phone:503-472-2985
Mailing Address - Fax:503-883-9165
Practice Address - Street 1:1027 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4417
Practice Address - Country:US
Practice Address - Phone:503-472-2985
Practice Address - Fax:503-883-9165
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR17311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR125083Medicaid
OR125083Medicaid