Provider Demographics
NPI:1336465046
Name:BROWN, BRENDA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1912
Mailing Address - Country:US
Mailing Address - Phone:607-785-5646
Mailing Address - Fax:
Practice Address - Street 1:1010 KNOLL DR
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-1912
Practice Address - Country:US
Practice Address - Phone:607-785-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0397871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical