Provider Demographics
NPI:1124626155
Name:BROWN, LAVERNE (LMHC, MCAP)
Entity type:Individual
Prefix:
First Name:LAVERNE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10964 BRIGHTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-7007
Mailing Address - Country:US
Mailing Address - Phone:646-934-3279
Mailing Address - Fax:
Practice Address - Street 1:10964 BRIGHTSIDE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-7007
Practice Address - Country:US
Practice Address - Phone:646-934-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health