Provider Demographics
NPI:1285414649
Name:BROWN, NICOLETTE LATRICE
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:LATRICE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 PARK BLVD APT 16
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1441
Mailing Address - Country:US
Mailing Address - Phone:510-495-7003
Mailing Address - Fax:
Practice Address - Street 1:2137 PARK BLVD APT 16
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1441
Practice Address - Country:US
Practice Address - Phone:510-495-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician