Provider Demographics
NPI:1992302632
Name:BROWN, LYNDA (LL,MSW)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LL,MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BUTTERNUT CT
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9418
Mailing Address - Country:US
Mailing Address - Phone:734-644-6698
Mailing Address - Fax:
Practice Address - Street 1:54 BUTTERNUT CT
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-9418
Practice Address - Country:US
Practice Address - Phone:734-644-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011073621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical