Healthcare Provider Details

I. General information

NPI: 1174141907
Provider Name (Legal Business Name): THOMAS E. BROWN, PHD, PSYCHOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S SEPULVEDA BLVD STE 218
MANHATTAN BEACH CA
90266-6976
US

IV. Provider business mailing address

500 S SEPULVEDA BLVD STE 218
MANHATTAN BEACH CA
90266-6976
US

V. Phone/Fax

Practice location:
  • Phone: 310-590-7181
  • Fax: 310-590-7183
Mailing address:
  • Phone: 310-590-7181
  • Fax: 310-590-7183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN J KENNEDY
Title or Position: ASSOCIATE DIRECTOR
Credential: DNP, FNP-C
Phone: 310-590-7181