Provider Demographics
NPI:1255369518
Name:BROWN, URSULA M (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:URSULA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3582
Mailing Address - Country:US
Mailing Address - Phone:973-509-0052
Mailing Address - Fax:973-857-8664
Practice Address - Street 1:460 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3582
Practice Address - Country:US
Practice Address - Phone:973-509-0052
Practice Address - Fax:973-857-8664
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000816001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3564382OtherOXFORD HEALTH PLANS
P3564382OtherOXFORD HEALTH PLANS