Individual provider Active NPI

Letitia Olivia Brown, LCSW

  • Clinical Social Worker
  • Bay Shore, NY
National Provider Identifier
1356422802
Registry record updated Jan 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
079892 Issued in NY
Practice address
1555 Sunrise Hwy
Suite 3E
Bay Shore, NY 11706-6027
Phone
(516) 761-0523
NPI assigned
Oct 18, 2006
Last updated
Jan 25, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 071967 NY
Clinical Social Worker 1041C0700X 079892 NY Primary

Addresses

Primary practice location

1555 Sunrise Hwy
Suite 3E
Bay Shore, NY 11706-6027

Mailing address

1555 Sunrise Hwy
Suite 3E
Bay Shore, NY 11706-6027
Phone (516) 761-0523

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121001000325 NY Practitioner - Clinical Social Worker 5597914853 Reassigns benefits to 1 organization
Practice locations: West Islip, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071967NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Letitia O. Brown LCSW, P.C. CurrentSince Mar 30, 2018 Accepting new patients
Genoa Healthcare LLC Past Accepting new patients

Locations

631 Montauk Hwy
Ste 5
West Islip, NY 11795
Phone (516) 761-0523

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390608000000",
    "number": "1356422802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 SUNRISE HWY",
            "address_2": "SUITE 3E",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117066027",
            "telephone_number": "516-761-0523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 SUNRISE HWY",
            "address_2": "SUITE 3E",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117066027",
            "telephone_number": "516-761-0523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "LETITIA",
        "middle_name": "OLIVIA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2014-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "071967",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "079892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

Verify at the official NPI Registry.