Healthcare Provider Details

I. General information

NPI: 1063729622
Provider Name (Legal Business Name): MS. MELANIE L. BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 PACIFIC AVE
LIVERMORE CA
94550-7062
US

IV. Provider business mailing address

507 LAKEVIEW DR
BRENTWOOD CA
94513-5061
US

V. Phone/Fax

Practice location:
  • Phone: 415-717-4270
  • Fax:
Mailing address:
  • Phone: 415-717-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: