Provider Demographics
NPI:1104877091
Name:BROWN, LILA D (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LILA
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LILA
Other - Middle Name:D
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3832 APOLLO DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4504
Mailing Address - Country:US
Mailing Address - Phone:907-764-5136
Mailing Address - Fax:
Practice Address - Street 1:3801 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5234
Practice Address - Country:US
Practice Address - Phone:907-212-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH3148Medicaid
AKMH3681Medicaid
AKMH3681Medicaid
AK152916Medicare PIN
AKMH3148Medicaid