Provider Demographics
NPI:1972630697
Name:BROWN, VERNON ELROY (PHD)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:ELROY
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 E 5TH ST
Mailing Address - Street 2:PO BOX 41
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-3134
Mailing Address - Country:US
Mailing Address - Phone:330-386-3844
Mailing Address - Fax:330-386-4129
Practice Address - Street 1:414 E 5TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3134
Practice Address - Country:US
Practice Address - Phone:330-386-3844
Practice Address - Fax:330-386-4129
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4651103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2343208Medicaid
1035210OtherCIGNA BEHAVIORAL
000000126028OtherANTHEM BC BS
721820000OtherMAGELLAN
1035210OtherCIGNA BEHAVIORAL
OHBRCP12942Medicare ID - Type Unspecified