Provider Demographics
NPI:1053720706
Name:BROWN, MATTHEW (LLMSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 PRESTWICK LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2858
Mailing Address - Country:US
Mailing Address - Phone:248-877-6524
Mailing Address - Fax:
Practice Address - Street 1:11457 SHOEMAKER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3418
Practice Address - Country:US
Practice Address - Phone:313-331-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010940351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical