Provider Demographics
NPI:1841842515
Name:BROWN, GWENIVERE S (MSW, LSW)
Entity type:Individual
Prefix:
First Name:GWENIVERE
Middle Name:S
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:GWENIVERE
Other - Middle Name:S
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 WINTER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2247
Mailing Address - Country:US
Mailing Address - Phone:937-992-1199
Mailing Address - Fax:
Practice Address - Street 1:2580 SHILOH SPRINGS RD #B
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426
Practice Address - Country:US
Practice Address - Phone:937-529-4376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.06004081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical