Provider Demographics
NPI:1386635746
Name:BROWN, LAUREL V (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:V
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 1:672 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-4610
Mailing Address - Country:US
Mailing Address - Phone:954-577-4113
Mailing Address - Fax:954-577-4138
Practice Address - Street 1:10250 NW 53RD ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-8023
Practice Address - Country:US
Practice Address - Phone:954-577-4113
Practice Address - Fax:954-577-4138
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW28991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766535100Medicaid
FLZ4761ZMedicare ID - Type Unspecified