Provider Demographics
NPI:1104121417
Name:BROWN, DAVID BENJAMIN JR (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BENJAMIN
Last Name:BROWN
Suffix:JR
Gender:M
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 1:1224 WAVERLY PL
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2627
Mailing Address - Country:US
Mailing Address - Phone:518-280-6355
Mailing Address - Fax:518-280-6355
Practice Address - Street 1:1541 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6001
Practice Address - Country:US
Practice Address - Phone:518-480-2173
Practice Address - Fax:518-280-6355
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040761-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical