Provider Demographics
NPI:1821342098
Name:BROWN, AMANDA LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:POSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1 SAINT MARY PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4343
Mailing Address - Country:US
Mailing Address - Phone:318-681-7113
Mailing Address - Fax:
Practice Address - Street 1:401 W 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-3034
Practice Address - Country:US
Practice Address - Phone:318-868-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10208104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker