Provider Demographics
NPI:1710121116
Name:BROWN, CHAD JOSEPH (LICSW)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:JOSEPH
Last Name:BROWN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 24TH AVE S
Mailing Address - Street 2:STE 102
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-9038
Mailing Address - Country:US
Mailing Address - Phone:701-941-0175
Mailing Address - Fax:701-941-3001
Practice Address - Street 1:4160 24TH AVE S
Practice Address - Street 2:STE 102
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-9038
Practice Address - Country:US
Practice Address - Phone:701-941-0175
Practice Address - Fax:701-941-3001
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN186621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19311Medicaid
MN800003120Medicare PIN
NDN718238Medicare PIN
ND19311Medicaid
NDN718237Medicare PIN