Healthcare Provider Details

I. General information

NPI: 1285076505
Provider Name (Legal Business Name): MR. CHRISTOPHER BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 12/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 CASTOR AVE
PHILADELPHIA PA
19152-2729
US

IV. Provider business mailing address

8220 CASTOR AVE
PHILADELPHIA PA
19152-2729
US

V. Phone/Fax

Practice location:
  • Phone: 215-687-1000
  • Fax: 215-745-6511
Mailing address:
  • Phone: 215-687-1000
  • Fax: 215-745-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number007258
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: