Provider Demographics
NPI:1417164138
Name:BROWN, CINDY L (LCSW)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
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 1:1023 YELLOWSTONE AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4478
Mailing Address - Country:US
Mailing Address - Phone:208-478-9551
Mailing Address - Fax:208-478-1507
Practice Address - Street 1:1023 YELLOWSTONE AVE
Practice Address - Street 2:SUITE J
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4478
Practice Address - Country:US
Practice Address - Phone:208-478-9551
Practice Address - Fax:208-478-1507
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 253471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical