Provider Demographics
NPI:1902466469
Name:BROWN, NEIL DAVID
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:DAVID
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CALEDONIA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-3307
Mailing Address - Country:US
Mailing Address - Phone:831-426-3522
Mailing Address - Fax:
Practice Address - Street 1:550 WATER ST STE D2
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4129
Practice Address - Country:US
Practice Address - Phone:831-426-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW68531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW6853OtherDEPARTMENT OF CONSUMER AFFAIRS