Provider Demographics
NPI:1154711653
Name:BROWN, C. (PSYD)
Entity type:Individual
Prefix:DR
First Name:C.
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 COLFAX AVE
Mailing Address - Street 2:B
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6881
Mailing Address - Country:US
Mailing Address - Phone:530-274-9509
Mailing Address - Fax:530-274-2062
Practice Address - Street 1:254 COLFAX AVE
Practice Address - Street 2:B
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6881
Practice Address - Country:US
Practice Address - Phone:530-274-9509
Practice Address - Fax:530-274-2062
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16887103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist