Individual provider Active NPI

Heather Rene Brown, LCSW

  • Clinical Social Worker
  • San Bernardino, CA
National Provider Identifier
1104950310
Registry record updated Oct 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
101538 Issued in CA
Practice address
1138 E 37TH St
San Bernardino, CA 92404-1816
Phone
(909) 809-7831
NPI assigned
Mar 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 30317 CA
Clinical Social Worker 1041C0700X
Clinical Social Worker 1041C0700X 76753 CA
Clinical Social Worker 1041C0700X 101538 CA Primary
Mental Health Counselor 101YM0800X ASW18018 CA

Addresses

Primary practice location

1138 E 37TH St
San Bernardino, CA 92404-1816

Mailing address

PO Box 18
Loma Linda, CA 92354-0018
Phone (909) 809-7831

Other identifiers 1

IdentifierTypeStateIssuer
ICAN726OtherCADMH STAFF CODE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
ASW18018CAMDMental Health Counselor
76753CAMDClinical Social Worker
30317CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Telecare Corporation PastSince Oct 1, 2019 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728172800000",
    "number": "1104950310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923540018",
            "telephone_number": "909-809-7831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 E 37TH ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924041816",
            "telephone_number": "909-809-7831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "HEATHER",
        "middle_name": "RENE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-16",
        "last_updated": "2024-10-06",
        "certification_date": "2024-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "30317",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "76753",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "101538",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW18018",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMH STAFF CODE",
            "identifier": "ICAN726",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.