Provider Demographics
NPI:1598904401
Name:BROWN, PAMELA MARTHA (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARTHA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N FEDERAL HWY
Mailing Address - Street 2:SUITE 103 ROOM C
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-2801
Mailing Address - Country:US
Mailing Address - Phone:561-703-0976
Mailing Address - Fax:561-483-2244
Practice Address - Street 1:20889 HAMACA CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2720
Practice Address - Country:US
Practice Address - Phone:561-703-0976
Practice Address - Fax:561-483-2244
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 67691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW 6769OtherFLORIDA LICENSE