Healthcare Provider Details

I. General information

NPI: 1841922598
Provider Name (Legal Business Name): AMY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 10/06/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S MAIN ST STE 105
AKRON OH
44308-1210
US

IV. Provider business mailing address

259 PERKINSWOOD BLVD NE APT B14
WARREN OH
44483-4466
US

V. Phone/Fax

Practice location:
  • Phone: 234-334-1223
  • Fax:
Mailing address:
  • Phone: 657-799-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: