Provider Demographics
NPI:1861166647
Name:WATSON BROWN, PATRICIA (LCADC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WATSON BROWN
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 TIFFANY BLVD APT 232
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2468
Mailing Address - Country:US
Mailing Address - Phone:973-620-3757
Mailing Address - Fax:973-620-3757
Practice Address - Street 1:131 POMONA AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2030
Practice Address - Country:US
Practice Address - Phone:973-620-3757
Practice Address - Fax:973-620-3757
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00170700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)