Provider Demographics
NPI:1326255100
Name:BROWN, NADINE ALTHEA
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:ALTHEA
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NADINE
Other - Middle Name:ALTHEA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:2717 YATES AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5330
Mailing Address - Country:US
Mailing Address - Phone:718-652-2405
Mailing Address - Fax:718-652-2405
Practice Address - Street 1:2717 YATES AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5330
Practice Address - Country:US
Practice Address - Phone:718-652-2405
Practice Address - Fax:718-652-2405
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053759-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical