Provider Demographics
NPI:1598289050
Name:BROWN, NATHANIEL HOLMES (LCSW)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:HOLMES
Last Name:BROWN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 S 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3369
Mailing Address - Country:US
Mailing Address - Phone:414-476-9675
Mailing Address - Fax:414-476-9615
Practice Address - Street 1:932 S 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3369
Practice Address - Country:US
Practice Address - Phone:414-476-9675
Practice Address - Fax:414-476-9615
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8723-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical