Provider Demographics
NPI:1326547258
Name:BROWN, IVAN (MSSW, CSW)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MSSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MEADOW VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8443
Mailing Address - Country:US
Mailing Address - Phone:859-608-6702
Mailing Address - Fax:
Practice Address - Street 1:501 DARBY CREEK RD STE 7
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1605
Practice Address - Country:US
Practice Address - Phone:859-227-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY253093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health