Provider Demographics
NPI:1053397372
Name:BROWN, PHILLIS M (LICSW)
Entity type:Individual
Prefix:MS
First Name:PHILLIS
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-2921
Mailing Address - Country:US
Mailing Address - Phone:781-646-6388
Mailing Address - Fax:781-316-8242
Practice Address - Street 1:1235 BROADWAY
Practice Address - Street 2:STE 9, ALEWIFE COUNSELING AND EXPRESSIVE THERAPIES
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-629-7881
Practice Address - Fax:781-316-8242
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1047011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P04910OtherBCBS
P04910Medicare ID - Type Unspecified