Provider Demographics
NPI:1285136002
Name:JACKSON-BROWN, IRENE (PHD, CSA, CMC)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:JACKSON-BROWN
Suffix:
Gender:F
Credentials:PHD, CSA, CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 COLORADO AVE NW FL 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3621
Mailing Address - Country:US
Mailing Address - Phone:202-722-4205
Mailing Address - Fax:
Practice Address - Street 1:5248 COLORADO AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3621
Practice Address - Country:US
Practice Address - Phone:202-722-4205
Practice Address - Fax:202-722-4205
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator