Provider Demographics
NPI:1194939579
Name:BROWN, WAYNE PETER (LCSW)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:PETER
Last Name:BROWN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:WAYNE
Other - Middle Name:P
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1467 NE 56TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-6111
Mailing Address - Country:US
Mailing Address - Phone:954-536-8257
Mailing Address - Fax:954-963-7169
Practice Address - Street 1:1467 NE 56TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-6111
Practice Address - Country:US
Practice Address - Phone:954-536-8257
Practice Address - Fax:954-963-7169
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW82101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical