Provider Demographics
NPI:1457860314
Name:BROWN, MAYA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W BROADWAY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2531
Mailing Address - Country:US
Mailing Address - Phone:612-886-4218
Mailing Address - Fax:800-640-5242
Practice Address - Street 1:1011 W BROADWAY AVE STE 110
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2531
Practice Address - Country:US
Practice Address - Phone:612-886-4218
Practice Address - Fax:800-640-5242
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891091666OtherNPI
05161979OtherBIRHTDATE