Provider Demographics
NPI:1669915104
Name:BROWN, PANDORA (MSW)
Entity type:Individual
Prefix:MRS
First Name:PANDORA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25245 5 MILE RD
Mailing Address - Street 2:STE 500
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3701
Mailing Address - Country:US
Mailing Address - Phone:313-255-2650
Mailing Address - Fax:
Practice Address - Street 1:12751 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1662
Practice Address - Country:US
Practice Address - Phone:248-259-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010696561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical