Healthcare Provider Details

I. General information

NPI: 1396232773
Provider Name (Legal Business Name): RICHARD L BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 EDALBERT DR
CINCINNATI OH
45239-7604
US

IV. Provider business mailing address

5400 EDALBERT DR
CINCINNATI OH
45239-7604
US

V. Phone/Fax

Practice location:
  • Phone: 855-577-7284
  • Fax:
Mailing address:
  • Phone: 855-577-7284
  • Fax: 513-559-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: