Provider Demographics
NPI:1356422802
Name:BROWN, LETITIA OLIVIA (LCSW)
Entity type:Individual
Prefix:
First Name:LETITIA
Middle Name:OLIVIA
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 1:1555 SUNRISE HWY
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6027
Mailing Address - Country:US
Mailing Address - Phone:516-761-0523
Mailing Address - Fax:
Practice Address - Street 1:1555 SUNRISE HWY
Practice Address - Street 2:SUITE 3E
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6027
Practice Address - Country:US
Practice Address - Phone:516-761-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2014-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0719671041C0700X
NY0798921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical