Provider Demographics
NPI:1417634924
Name:BROWN, JODY (M ED, CRC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:M ED, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SE 2ND ST STE 600
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1950
Mailing Address - Country:US
Mailing Address - Phone:954-281-2647
Mailing Address - Fax:754-755-3406
Practice Address - Street 1:11633 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4101
Practice Address - Country:US
Practice Address - Phone:561-485-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH23953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health