1437150166 NPI number — ROBERT LEROY BROWN MSW, LCSW

Table of content: ROBERT LEROY BROWN MSW, LCSW (NPI 1437150166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437150166 NPI number — ROBERT LEROY BROWN MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
ROBERT
Provider Middle Name:
LEROY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
BOB
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1437150166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1481 W. 10TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-988-5292
Provider Business Mailing Address Fax Number:
317-988-5203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 WEST HONEYCREEK PARKWAY
Provider Second Line Business Practice Location Address:
TERRE HAUTE VA EAST CLINIC
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-8325
Provider Business Practice Location Address Fax Number:
812-232-8717
Provider Enumeration Date:
08/03/2005

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:  34003581A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000188299 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 343416 . This is a "MHN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".