Provider Demographics
NPI:1609574821
Name:BROWN-JETERS, MARIAMA SARA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARIAMA
Middle Name:SARA
Last Name:BROWN-JETERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 N MAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1862
Mailing Address - Country:US
Mailing Address - Phone:312-303-0500
Mailing Address - Fax:
Practice Address - Street 1:4044 N LINCOLN AVE STE 198
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3038
Practice Address - Country:US
Practice Address - Phone:773-217-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)