Provider Demographics
NPI:1316756265
Name:BROWN, DARRYL EVAN
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:EVAN
Last Name:BROWN
Suffix:
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 1:3375 LAWSONIA RD
Mailing Address - Street 2:
Mailing Address - City:CRISFIELD
Mailing Address - State:MD
Mailing Address - Zip Code:21817-2215
Mailing Address - Country:US
Mailing Address - Phone:856-956-9008
Mailing Address - Fax:
Practice Address - Street 1:3375 LAWSONIA RD
Practice Address - Street 2:
Practice Address - City:CRISFIELD
Practice Address - State:MD
Practice Address - Zip Code:21817-2215
Practice Address - Country:US
Practice Address - Phone:856-956-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-22-216329106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician