Provider Demographics
NPI:1174758577
Name:BROWN, JEROME DAVID (LMSW)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:DAVID
Last Name:BROWN
Suffix:
Gender:M
Credentials:LMSW
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 527896
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-7896
Mailing Address - Country:US
Mailing Address - Phone:718-812-2473
Mailing Address - Fax:
Practice Address - Street 1:8929 163RD ST
Practice Address - Street 2:APT. 5M
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5084
Practice Address - Country:US
Practice Address - Phone:718-812-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060445-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker