Provider Demographics
NPI:1518729144
Name:BROWN, NICOLE RENE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 E RIVER RD STE 401
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3777
Mailing Address - Country:US
Mailing Address - Phone:763-780-3307
Mailing Address - Fax:763-780-3306
Practice Address - Street 1:1551 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3218
Practice Address - Country:US
Practice Address - Phone:763-780-3307
Practice Address - Fax:763-780-3306
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical