Provider Demographics
NPI:1699096917
Name:BROWN, STEPHANIE DIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DIANE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 BURGESS DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3475
Mailing Address - Country:US
Mailing Address - Phone:650-322-0943
Mailing Address - Fax:
Practice Address - Street 1:445 BURGESS DR STE 150
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3475
Practice Address - Country:US
Practice Address - Phone:650-322-0943
Practice Address - Fax:650-327-0738
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6851103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical