Provider Demographics
NPI:1609133305
Name:BROWN, MICHAEL FREDERICK (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:BROWN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BROMPTON RD
Mailing Address - Street 2:3X
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3453
Mailing Address - Country:US
Mailing Address - Phone:516-241-6331
Mailing Address - Fax:
Practice Address - Street 1:50 BROMPTON RD
Practice Address - Street 2:3X
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3453
Practice Address - Country:US
Practice Address - Phone:516-241-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064207-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical