Provider Demographics
NPI:1053119198
Name:BROWN, SHANDA L (LSW)
Entity type:Individual
Prefix:
First Name:SHANDA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1131
Mailing Address - Country:US
Mailing Address - Phone:973-264-8289
Mailing Address - Fax:
Practice Address - Street 1:17 ACADEMY ST STE 308
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2934
Practice Address - Country:US
Practice Address - Phone:973-692-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical