MEDICARE: DR. LEWIS MICHAEL BROWN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	09119-1	NY
2	103T00000X	Psychologist	1076	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114918885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS MICHAEL BROWN PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 170297
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-0297
Country	:	US
Telephone Number	:	718-834-1646
Fax Number	:	718-834-1323

Provider Business Practice Location Address
First Line	:	68 SAINT MARKS PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1945
Country	:	US
Telephone Number	:	718-834-1646
Fax Number	:	718-834-1323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	06/04/2008

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