Provider Demographics
NPI:1811445679
Name:CLAIRE L BROWN LCSW PC
Entity type:Organization
Organization Name:CLAIRE L BROWN LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:LOIUSE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-477-4024
Mailing Address - Street 1:350 E. CONGRESS
Mailing Address - Street 2:SUITE L
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6284
Mailing Address - Country:US
Mailing Address - Phone:815-477-4024
Mailing Address - Fax:815-356-7139
Practice Address - Street 1:350 E CONGRESS PKWY
Practice Address - Street 2:SUITE L
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6284
Practice Address - Country:US
Practice Address - Phone:815-477-4024
Practice Address - Fax:815-356-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.002685251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210347Medicare PIN