Provider Demographics
NPI:1053189332
Name:BROWN, NIKISHA SIMONE (LCSW)
Entity type:Individual
Prefix:
First Name:NIKISHA
Middle Name:SIMONE
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:PO BOX 8541
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-8541
Mailing Address - Country:US
Mailing Address - Phone:951-442-0934
Mailing Address - Fax:
Practice Address - Street 1:3061 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-6908
Practice Address - Country:US
Practice Address - Phone:951-442-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1083371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical