Provider Demographics
NPI:1407994940
Name:BROWN, MILLICENT L (PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:MILLICENT
Middle Name:L
Last Name:BROWN
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:DR
Other - First Name:MILLICENT
Other - Middle Name:L
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:5640 HALSEY TRCE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8755
Mailing Address - Country:US
Mailing Address - Phone:347-938-9246
Mailing Address - Fax:404-346-9510
Practice Address - Street 1:212 5TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6408
Practice Address - Country:US
Practice Address - Phone:917-864-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303967-1363LA2200X
GARN178172363LA2200X, 363LP0808X
NYF303967-01363LA2200X
NYF403183-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA318335117BMedicaid
NYF403183-01Medicaid
GA003239266AMedicaid
GAMH5982740OtherDEA
GA318335117BMedicaid