Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ASW #37076 | CA |
N | 1041C0700X | Clinical Social Worker | ASW37076 | CA |
Y | 1041C0700X | Clinical Social Worker | LCSW76285 | CA |
NPI | 1003256280 |
---|---|
Provider Name | Mrs. Kaitlyn W Brown |
First Address | Roseville, CA 95747-5156 |
Second Address | Roseville, CA 95747-5156 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2013 |
Last Update Date | 30/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
76285 | BBS (01) | CA |