Provider Demographics
NPI:1093540221
Name:BROWN BARNUM, DEONTAE (CCHW)
Entity type:Individual
Prefix:
First Name:DEONTAE
Middle Name:
Last Name:BROWN BARNUM
Suffix:
Gender:M
Credentials:CCHW
Other - Prefix:
Other - First Name:TAE
Other - Middle Name:
Other - Last Name:BROWN BARNUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCHW
Mailing Address - Street 1:1348 BAINBRIDGE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1810
Mailing Address - Country:US
Mailing Address - Phone:267-467-6934
Mailing Address - Fax:
Practice Address - Street 1:1348 BAINBRIDGE ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1810
Practice Address - Country:US
Practice Address - Phone:267-389-3021
Practice Address - Fax:267-389-3021
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20784172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker