Provider Demographics
NPI:1811287295
Name:BROWN, CRYSTALENE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CRYSTALENE
Middle Name:
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 1:1010 E ADAMS ST
Mailing Address - Street 2:SUITE 136
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-1902
Mailing Address - Country:US
Mailing Address - Phone:904-351-6730
Mailing Address - Fax:888-857-4194
Practice Address - Street 1:1010 E ADAMS ST
Practice Address - Street 2:SUITE 136
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-1902
Practice Address - Country:US
Practice Address - Phone:904-351-6730
Practice Address - Fax:888-857-4194
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 42491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical