Healthcare Provider Details

I. General information

NPI: 1215357165
Provider Name (Legal Business Name): BETTYNA BROWN MA, ED.S, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E MADISON AVE
MAGNOLIA NJ
08049-1409
US

IV. Provider business mailing address

607 LAMBERTON ST
TRENTON NJ
08611-2911
US

V. Phone/Fax

Practice location:
  • Phone: 856-361-2720
  • Fax: 856-309-9716
Mailing address:
  • Phone: 609-222-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00487400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: