Provider Demographics
NPI:1295106235
Name:BROWN, KAITLIN JAN (LCSW)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:JAN
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 1:1606 OLD ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-1049
Mailing Address - Country:US
Mailing Address - Phone:914-328-0793
Mailing Address - Fax:
Practice Address - Street 1:1606 OLD ORCHARD ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-1049
Practice Address - Country:US
Practice Address - Phone:914-328-0794
Practice Address - Fax:914-328-6954
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083942104100000X
NJ44SL05712200104100000X
NY0841261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker