Provider Demographics
NPI:1619942430
Name:BROWN, MARIJKE M (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIJKE
Middle Name:M
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 1:2711 NORTHSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-1853
Mailing Address - Country:US
Mailing Address - Phone:574-234-8289
Mailing Address - Fax:
Practice Address - Street 1:406 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2323
Practice Address - Country:US
Practice Address - Phone:574-234-0061
Practice Address - Fax:574-283-1209
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340039471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S89657Medicare UPIN
IN237580JJMedicare ID - Type Unspecified