Provider Demographics
NPI:1356558886
Name:BROWN, JUDITH RHENA (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:RHENA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2314
Mailing Address - Country:US
Mailing Address - Phone:716-861-8061
Mailing Address - Fax:
Practice Address - Street 1:80 GOODRICH ST
Practice Address - Street 2:MICA UNIT
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1005
Practice Address - Country:US
Practice Address - Phone:716-859-2176
Practice Address - Fax:716-859-2560
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056378-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR056378-1OtherLICENSE NUMBER