Provider Demographics
NPI:1427500271
Name:BROWN, JESSICA ASHLEY
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ASHLEY
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4652 MIRAMAR DR
Mailing Address - Street 2:APT 5217
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3346
Mailing Address - Country:US
Mailing Address - Phone:631-672-0031
Mailing Address - Fax:
Practice Address - Street 1:1735 MARTIN LUTHER KING ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-2404
Practice Address - Country:US
Practice Address - Phone:727-502-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor