Provider Demographics
NPI:1467806943
Name:O SHEA BROWN, GILLIAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:
Last Name:O SHEA BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:GILLIAN
Other - Middle Name:
Other - Last Name:O SHEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:928 BROADWAY STE 400
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8149
Mailing Address - Country:US
Mailing Address - Phone:410-343-7590
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8149
Practice Address - Country:US
Practice Address - Phone:410-343-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2018-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD216431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21643OtherBOARD OF EXAMINERS FOR SOCIAL WORK
NY087644OtherNEW YORK LICENSE