Provider Demographics
NPI:1932307428
Name:BROWN, CAROLYN JOAN (LICSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JOAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3584
Mailing Address - Country:US
Mailing Address - Phone:612-871-0805
Mailing Address - Fax:612-871-0455
Practice Address - Street 1:412 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3584
Practice Address - Country:US
Practice Address - Phone:612-871-0805
Practice Address - Fax:612-871-0455
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN132641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical