Healthcare Provider Details

I. General information

NPI: 1508426958
Provider Name (Legal Business Name): JONATHAN BROWN PHD, MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MILLER AVE STE 101
MILL VALLEY CA
94941-2851
US

IV. Provider business mailing address

275 MILLER AVE STE 101
MILL VALLEY CA
94941-2851
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-2990
  • Fax:
Mailing address:
  • Phone: 415-383-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY14513
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY14513
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY14513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: