Provider Demographics
NPI:1104918473
Name:BROWN, JEROME (PHD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:713-592-8952
Mailing Address - Fax:713-592-9266
Practice Address - Street 1:6565 WEST LOOP S
Practice Address - Street 2:SUITE 600
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3500
Practice Address - Country:US
Practice Address - Phone:713-592-8952
Practice Address - Fax:713-592-9266
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20353103TC0700X
TX6433103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSD77OtherBLUE CROSS BLUE SHIELD
TXP000SD776Medicaid
TXP000SD776Medicaid