Provider Demographics
NPI:1528751237
Name:BROWN, MATTHEW ELIJAH (LCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ELIJAH
Last Name:BROWN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1811
Mailing Address - Country:US
Mailing Address - Phone:573-291-6073
Mailing Address - Fax:
Practice Address - Street 1:1025 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1811
Practice Address - Country:US
Practice Address - Phone:573-291-6073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220349391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical