Provider Demographics
NPI:1861609497
Name:BROWN, LEONA PHYLLIS (LCMHC)
Entity type:Individual
Prefix:MS
First Name:LEONA
Middle Name:PHYLLIS
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101
Mailing Address - Country:US
Mailing Address - Phone:802-463-1404
Mailing Address - Fax:802-463-4180
Practice Address - Street 1:134 ROCKINGHAM STREET
Practice Address - Street 2:
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101
Practice Address - Country:US
Practice Address - Phone:802-463-1404
Practice Address - Fax:802-463-4180
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1079903OtherCIGNA
287324OtherMAGELLAN
VT38027OtherBLUE CROSS BLUE SHIELD
VT1006864Medicaid
NH30421864OtherNH MEDICAID
25421OtherMATTHEW THORNTON
7821189OtherAETNA
61401OtherMVP