Provider Demographics
NPI:1962803387
Name:BROWN, IRENE VERONICA (MASTERS MHC)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:VERONICA
Last Name:BROWN
Suffix:
Gender:F
Credentials:MASTERS MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 SW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5668
Mailing Address - Country:US
Mailing Address - Phone:239-989-8410
Mailing Address - Fax:
Practice Address - Street 1:2740 OAK RIDGE CT STE 301
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9371
Practice Address - Country:US
Practice Address - Phone:239-989-8410
Practice Address - Fax:239-931-4444
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14403101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor