Provider Demographics
NPI:1376662742
Name:BROWN, KRISTIN W (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:W
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:L
Other - Last Name:WEITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:214 KING ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-1142
Mailing Address - Country:US
Mailing Address - Phone:315-713-5720
Mailing Address - Fax:315-713-5741
Practice Address - Street 1:214 KING ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-1142
Practice Address - Country:US
Practice Address - Phone:315-713-5720
Practice Address - Fax:315-713-5741
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076468104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker