Provider Demographics
NPI:1396138897
Name:BROWN, HEATHER LEIGH (PSYCHOLOGY ASSOCIATE)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LEIGH
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYCHOLOGY ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31296 FANLEAF CT
Mailing Address - Street 2:
Mailing Address - City:PARSONSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21849-2581
Mailing Address - Country:US
Mailing Address - Phone:443-614-8682
Mailing Address - Fax:
Practice Address - Street 1:111 CAMDEN ST FL 1
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4916
Practice Address - Country:US
Practice Address - Phone:410-860-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0374101YA0400X
MDA0016390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD520202702Medicaid
MD520202700Medicaid
MD609550001Medicaid
MD609550004Medicaid