Provider Demographics
NPI:1366650475
Name:BROWN, MARK L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:L
Last Name:BROWN
Suffix:
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:466 CENTRAL AVE
Mailing Address - Street 2:SUITE 44
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3041
Mailing Address - Country:US
Mailing Address - Phone:847-414-5425
Mailing Address - Fax:847-433-1822
Practice Address - Street 1:466 CENTRAL AVE
Practice Address - Street 2:SUITE 44
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3041
Practice Address - Country:US
Practice Address - Phone:847-414-5425
Practice Address - Fax:847-433-1822
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical