Healthcare Provider Details

I. General information

NPI: 1134348790
Provider Name (Legal Business Name): MRS. ELAINE MARIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 ATLANTA AVE STE D3
RIVERSIDE CA
92507-7418
US

IV. Provider business mailing address

2006 11TH ST
RIVERSIDE CA
92507-5209
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8000
  • Fax: 951-955-8010
Mailing address:
  • Phone: 951-955-8000
  • Fax: 951-955-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: