Provider Demographics
NPI:1518023928
Name:BROWN, PHYLLIS ANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:ANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2736
Mailing Address - Country:US
Mailing Address - Phone:917-750-7522
Mailing Address - Fax:718-815-3399
Practice Address - Street 1:633 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2736
Practice Address - Country:US
Practice Address - Phone:917-750-7522
Practice Address - Fax:718-815-3399
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014090103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent