Provider Demographics
NPI:1215062625
Name:BROWN, MARK C (PHD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
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 1:1188 BELL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-6101
Mailing Address - Country:US
Mailing Address - Phone:440-338-3214
Mailing Address - Fax:440-338-3215
Practice Address - Street 1:1188 BELL RD STE 202
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-6101
Practice Address - Country:US
Practice Address - Phone:440-338-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0322609Medicaid
OHBRCP02741Medicare ID - Type Unspecified