Provider Demographics
NPI:1275025736
Name:BROWN, WAYNE N (LCSW, EDM)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:N
Last Name:BROWN
Suffix:
Gender:M
Credentials:LCSW, EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1408
Mailing Address - Country:US
Mailing Address - Phone:716-225-4789
Mailing Address - Fax:
Practice Address - Street 1:1925 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1408
Practice Address - Country:US
Practice Address - Phone:716-225-4789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
NY104121-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker