Provider Demographics
NPI:1477633048
Name:BROWN, KRISTEN D (LICSW/LCDP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:LICSW/LCDP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:D
Other - Last Name:SCELSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:43 ECONOMY AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-4003
Mailing Address - Country:US
Mailing Address - Phone:401-739-6780
Mailing Address - Fax:
Practice Address - Street 1:43 ECONOMY AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-4003
Practice Address - Country:US
Practice Address - Phone:401-739-6780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00171101YA0400X
RIISW007721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30499-5OtherBLUE CROSS
RIKB56401Medicaid
RI62-83322OtherUBH
RI406303OtherBLUE CHIP
RIKB56401Medicaid