Healthcare Provider Details

I. General information

NPI: 1740293265
Provider Name (Legal Business Name): LAWRENCE OWEN BROWN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 BEACH AVE
LARCHMONT NY
10538-4030
US

IV. Provider business mailing address

71 BEACH AVE
LARCHMONT NY
10538-4030
US

V. Phone/Fax

Practice location:
  • Phone: 914-833-2133
  • Fax: 914-833-2133
Mailing address:
  • Phone: 914-833-2133
  • Fax: 914-833-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4640
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: