Provider Demographics
NPI:1558050401
Name:BROWN, JOAN LEE (RN, LMSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN, LMSW
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:LEE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, LMSW
Mailing Address - Street 1:5179 CHRISTINE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1549
Mailing Address - Country:US
Mailing Address - Phone:734-678-9021
Mailing Address - Fax:
Practice Address - Street 1:5179 CHRISTINE CT
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1549
Practice Address - Country:US
Practice Address - Phone:734-678-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704106673163W00000X
MI68010146151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse