Provider Demographics
NPI:1760558761
Name:BROWN, PENELOPE (MSW)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 UPLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1630
Mailing Address - Country:US
Mailing Address - Phone:508-473-5888
Mailing Address - Fax:
Practice Address - Street 1:258 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01746-2506
Practice Address - Country:US
Practice Address - Phone:508-473-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1043011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
347316OtherMAGELLAN BEHAV HEALTH
MABRPO2122OtherBLUE CROSS OF MA