Healthcare Provider Details

I. General information

NPI: 1578600763
Provider Name (Legal Business Name): JENNIFER R BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ROSE MILLER MD

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5054
  • Fax: 617-499-5465
Mailing address:
  • Phone: 617-499-5054
  • Fax: 617-499-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number231331
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number231331
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: