1184198194 NPI number — SUSAN BROWN, LCMHC, LLC

Table of content: (NPI 1184198194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184198194 NPI number — SUSAN BROWN, LCMHC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN BROWN, LCMHC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184198194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 BIRCHES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR HILL
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03586-4417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-823-7701
Provider Business Mailing Address Fax Number:
603-768-4255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 COTTAGE ST STE 2B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03561-4218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-823-7701
Provider Business Practice Location Address Fax Number:
603-768-4255
Provider Enumeration Date:
01/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CLINICIAN
Authorized Official Telephone Number:
603-823-7701

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1022892 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3094102 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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