Provider Demographics
NPI:1366119406
Name:MARSHA D BROWN PHD P A
Entity type:Organization
Organization Name:MARSHA D BROWN PHD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-979-3743
Mailing Address - Street 1:757 SE 17TH ST # 622
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2960
Mailing Address - Country:US
Mailing Address - Phone:917-979-3743
Mailing Address - Fax:954-743-0265
Practice Address - Street 1:757 SE 17TH ST # 622
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2960
Practice Address - Country:US
Practice Address - Phone:917-979-3743
Practice Address - Fax:954-743-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty