Provider Demographics
NPI:1750556551
Name:BROWN, MARTHA K (LCSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:K
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 1:415 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1230
Mailing Address - Country:US
Mailing Address - Phone:812-436-4232
Mailing Address - Fax:812-422-7558
Practice Address - Street 1:401 JOHN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-2733
Practice Address - Country:US
Practice Address - Phone:812-492-8330
Practice Address - Fax:812-492-8333
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002958A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN153874OtherSIHO
IN11489726OtherCAQH
IN839090005OtherMEDICARE
IN000000859951OtherANTHEM
IN210780VVMedicare PIN