Provider Demographics
NPI:1194534891
Name:BROWN, PHILLIP J SR
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:J
Last Name:BROWN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:IND HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2827
Mailing Address - Country:US
Mailing Address - Phone:973-277-2462
Mailing Address - Fax:
Practice Address - Street 1:619 S 17TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-1159
Practice Address - Country:US
Practice Address - Phone:973-374-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00782800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health