Healthcare Provider Details

I. General information

NPI: 1174172936
Provider Name (Legal Business Name): CORINNA ANN BROWN LCAT, BC-DMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

112 W 27TH ST STE 402
NEW YORK NY
10001-6241
US

IV. Provider business mailing address

105 LEXINGTON AVE APT 1B
BROOKLYN NY
11238-1762
US

V. Phone/Fax

Practice location:
  • Phone: 917-664-8230
  • Fax:
Mailing address:
  • Phone: 917-664-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number0000208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: