1336755370 NPI number — IMARI JACOYA BROWER LCSWA

Table of content: IMARI JACOYA BROWER LCSWA (NPI 1336755370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336755370 NPI number — IMARI JACOYA BROWER LCSWA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWER
Provider First Name:
IMARI
Provider Middle Name:
JACOYA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSWA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWER
Provider Other First Name:
IMARI
Provider Other Middle Name:
JACOYA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
IMARI J. BROWER
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336755370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 SUMMERTREE LN APT G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27406-5635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-407-3041
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 SUMMERTREE LN APT G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27406-5635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-407-3041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  P014821 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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