Provider Demographics
NPI:1538784129
Name:BROWN, CRYSTAL MONIQUE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MONIQUE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTURY 21 DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-7702
Mailing Address - Country:US
Mailing Address - Phone:904-207-1627
Mailing Address - Fax:
Practice Address - Street 1:6859 BELFORT OAKS PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6242
Practice Address - Country:US
Practice Address - Phone:800-356-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician