Provider Demographics
NPI:1902684418
Name:JEN MALCOLM-BROWN, PLLC
Entity Type:Organization
Organization Name:JEN MALCOLM-BROWN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALCOLM-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-450-0001
Mailing Address - Street 1:72 WENDELL RD
Mailing Address - Street 2:
Mailing Address - City:SHUTESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01072-9716
Mailing Address - Country:US
Mailing Address - Phone:413-450-0001
Mailing Address - Fax:413-450-0009
Practice Address - Street 1:110 N HILLSIDE RD STE 21
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9727
Practice Address - Country:US
Practice Address - Phone:413-450-0001
Practice Address - Fax:413-450-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health