Provider Demographics
NPI:1437541802
Name:BROWN, ALICE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 CHICAGO AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1055
Mailing Address - Country:US
Mailing Address - Phone:612-827-3028
Mailing Address - Fax:612-823-4993
Practice Address - Street 1:4826 CHICAGO AVE STE 105
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1055
Practice Address - Country:US
Practice Address - Phone:612-827-3028
Practice Address - Fax:612-823-4993
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN240011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical