Provider Demographics
NPI:1588973614
Name:BROWN, JENNIFER LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19254 ROGERS CLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-4010
Mailing Address - Country:US
Mailing Address - Phone:804-633-9997
Mailing Address - Fax:540-371-3753
Practice Address - Street 1:19254 ROGERS CLARK BLVD
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546
Practice Address - Country:US
Practice Address - Phone:804-633-9997
Practice Address - Fax:540-371-3753
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040109251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical