Provider Demographics
NPI:1144629189
Name:BROWN, SUSAN (LCSW-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 40TH ST STE 358
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2111
Mailing Address - Country:US
Mailing Address - Phone:443-350-0813
Mailing Address - Fax:484-805-7166
Practice Address - Street 1:711 W 40TH ST STE 358
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2111
Practice Address - Country:US
Practice Address - Phone:443-350-0813
Practice Address - Fax:484-805-7166
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0811807 00Medicaid