Provider Demographics
NPI:1326172768
Name:BROWN, ALEXANDER (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CHURCH ST # 515
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3624
Mailing Address - Country:US
Mailing Address - Phone:847-864-8650
Mailing Address - Fax:
Practice Address - Street 1:1007 CHURCH ST # 515
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3624
Practice Address - Country:US
Practice Address - Phone:847-864-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL352790Medicare ID - Type UnspecifiedMEDICARE NUMBER