Provider Demographics
NPI:1861545667
Name:BROWN, KENDRA (PHD)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2908
Mailing Address - Country:US
Mailing Address - Phone:772-781-8724
Mailing Address - Fax:772-219-4785
Practice Address - Street 1:428 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2908
Practice Address - Country:US
Practice Address - Phone:772-781-8724
Practice Address - Fax:772-219-4785
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4592103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59359OtherBLUE CROSS BLUE SHIELD
FL7345655002OtherGHI
FLFL1944OtherBRADMAN UNIPSYCH
FL090406OtherVALUE OPTIONS
FL7345655002OtherGHI
FL59359Medicare ID - Type UnspecifiedMEDICARE