Provider Demographics
NPI:1851811509
Name:PICKERSGILL-BROWN, DONNA (BS, CASAC-T)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:PICKERSGILL-BROWN
Suffix:
Gender:F
Credentials:BS, CASAC-T
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, RECOVERY COACH
Mailing Address - Street 1:17020 130TH AVE APT 6A
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3226
Mailing Address - Country:US
Mailing Address - Phone:347-321-5606
Mailing Address - Fax:
Practice Address - Street 1:17020 130TH AVE APT 6A
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3226
Practice Address - Country:US
Practice Address - Phone:347-321-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25522101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY25522OtherCASAC-T