Provider Demographics
NPI:1336535343
Name:BROWN, RACQUEAL (LCSW-C)
Entity Type:Individual
Prefix:
First Name:RACQUEAL
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 LODGE POLE CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5449
Mailing Address - Country:US
Mailing Address - Phone:443-822-8486
Mailing Address - Fax:
Practice Address - Street 1:1516 LODGE POLE CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5449
Practice Address - Country:US
Practice Address - Phone:443-822-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD188491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical