Provider Demographics
NPI:1265538474
Name:BROWN-GILPIN, MARCI (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARCI
Middle Name:
Last Name:BROWN-GILPIN
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:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:BLACK CANYON CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85324-0635
Mailing Address - Country:US
Mailing Address - Phone:602-819-6787
Mailing Address - Fax:815-331-5323
Practice Address - Street 1:18850 E SCHOOL HOUSE RD
Practice Address - Street 2:3
Practice Address - City:BLACK CANYON CITY
Practice Address - State:AZ
Practice Address - Zip Code:85324-8787
Practice Address - Country:US
Practice Address - Phone:602-819-6787
Practice Address - Fax:815-331-5323
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-10086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78359Medicare ID - Type Unspecified
AZWCMBNMedicare UPIN