Provider Demographics
NPI:1104286046
Name:BROWN, KATHRYN JOANNE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JOANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 N OAKLAND BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1572
Mailing Address - Country:US
Mailing Address - Phone:248-396-7390
Mailing Address - Fax:
Practice Address - Street 1:1370 N OAKLAND BLVD STE 105
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1572
Practice Address - Country:US
Practice Address - Phone:248-666-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI6801096946101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801096946OtherSTATE OF MI