Provider Demographics
NPI:1760090559
Name:BROWN, CAROLINE GRACE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:GRACE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BROADWAY RM 905
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2001
Mailing Address - Country:US
Mailing Address - Phone:917-410-0639
Mailing Address - Fax:
Practice Address - Street 1:111 BROADWAY RM 905
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2001
Practice Address - Country:US
Practice Address - Phone:917-410-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker