Provider Demographics
NPI:1932373354
Name:BROWN, CHARLES JAY (LISW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JAY
Last Name:BROWN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 INGERSOLL AVENUE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4015
Mailing Address - Country:US
Mailing Address - Phone:515-244-1416
Mailing Address - Fax:
Practice Address - Street 1:2940 INGERSOLL AVENUE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4015
Practice Address - Country:US
Practice Address - Phone:515-244-1416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical