Provider Demographics
NPI:1861765356
Name:BROWN, JILL (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-3108
Mailing Address - Country:US
Mailing Address - Phone:631-567-1640
Mailing Address - Fax:
Practice Address - Street 1:193 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-3108
Practice Address - Country:US
Practice Address - Phone:631-567-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045241-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical