Healthcare Provider Details

I. General information

NPI: 1962483479
Provider Name (Legal Business Name): PATRICIA I M BROWN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117713 US HWY 84 285
SANTA FE NM
87506
US

IV. Provider business mailing address

17713 US HIGHWAY 84-285
SANTA FE NM
87506-2668
US

V. Phone/Fax

Practice location:
  • Phone: 505-455-2268
  • Fax: 505-455-2122
Mailing address:
  • Phone: 505-455-2268
  • Fax: 505-455-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number150
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240433
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3734
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: