Provider Demographics
NPI:1821408915
Name:BROWN, PAULETTE (LISW-S)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 MAHONING AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2600
Mailing Address - Country:US
Mailing Address - Phone:330-318-3436
Mailing Address - Fax:330-319-8800
Practice Address - Street 1:3212 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2600
Practice Address - Country:US
Practice Address - Phone:330-318-3436
Practice Address - Fax:330-319-8800
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.13022011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical