Healthcare Provider Details

I. General information

NPI: 1093683161
Provider Name (Legal Business Name): MARTISHA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S WARNER RD STE 130
KING OF PRUSSIA PA
19406-2826
US

IV. Provider business mailing address

409 DEEMERS LNDG
HISTORIC NEW CASTLE DE
19720-7206
US

V. Phone/Fax

Practice location:
  • Phone: 484-441-3413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: