Provider Demographics
NPI:1518965706
Name:TOKLE BROWN, CAROLYN J (LISW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:TOKLE BROWN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:J
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:827 PASEO DEL PUEBLO NORTE
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6887
Mailing Address - Country:US
Mailing Address - Phone:575-770-7851
Mailing Address - Fax:575-758-0148
Practice Address - Street 1:414 CHAMISA RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5240
Practice Address - Country:US
Practice Address - Phone:575-770-7835
Practice Address - Fax:575-758-0148
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-088091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3693580Medicaid
TN3693580Medicaid