Provider Demographics
NPI:1003256280
Name:BROWN, KAITLYN W (MSW)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:W
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:W
Other - Last Name:PERCIVAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1430 BLUE OAKS BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5156
Mailing Address - Country:US
Mailing Address - Phone:916-822-9892
Mailing Address - Fax:
Practice Address - Street 1:1430 BLUE OAKS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5156
Practice Address - Country:US
Practice Address - Phone:916-822-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW370761041C0700X
CAASW #37076101YM0800X
CALCSW762851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA76285OtherBBS