Provider Demographics
NPI:1811092653
Name:BROWN, NAN (MSW)
Entity type:Individual
Prefix:MS
First Name:NAN
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:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:LINCOLNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10540
Mailing Address - Country:US
Mailing Address - Phone:914-248-6833
Mailing Address - Fax:
Practice Address - Street 1:65 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1347
Practice Address - Country:US
Practice Address - Phone:914-248-6833
Practice Address - Fax:845-258-4611
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSWPR02232411041C0700X
NJ44SC000104001041C0700X
NYPR0223241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N6V611Medicare ID - Type Unspecified
NYN27711Medicare ID - Type Unspecified