Healthcare Provider Details

I. General information

NPI: 1407302177
Provider Name (Legal Business Name): KENDRIA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10641 AIRPORT PULLING ROAD
NAPLES FL
34109
US

IV. Provider business mailing address

2069 RIVER REACH DR APT 424
NAPLES FL
34104-7920
US

V. Phone/Fax

Practice location:
  • Phone: 239-293-7387
  • Fax:
Mailing address:
  • Phone: 603-738-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21648
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH19698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: