Provider Demographics
NPI:1942675046
Name:BROWN, KORI A (LCSW)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S CARSON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5292
Mailing Address - Country:US
Mailing Address - Phone:631-772-9644
Mailing Address - Fax:
Practice Address - Street 1:4745 OGLETOWN STANTON RD STE 237
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2074
Practice Address - Country:US
Practice Address - Phone:302-320-2100
Practice Address - Fax:302-623-7942
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW603120051041C0700X
DEQ1-00120841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical