Healthcare Provider Details

I. General information

NPI: 1528319266
Provider Name (Legal Business Name): PAMELA CHERYL BROWN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 05/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST
ORLANDO FL
32803-8208
US

IV. Provider business mailing address

1500 SILVERSTONE AVE
ORLANDO FL
32806-1873
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-5500
  • Fax:
Mailing address:
  • Phone: 407-451-1086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number12-09P
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number12-09P
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number12-09P
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number12-09P
License Number StateAR
# 5
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number12-09P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: