Healthcare Provider Details

I. General information

NPI: 1538513197
Provider Name (Legal Business Name): DONOVAN OLIVER BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 PELHAM RD APT 1A
PHILADELPHIA PA
19119-4002
US

IV. Provider business mailing address

555 PELHAM RD APT 1A
PHILADELPHIA PA
19119-4002
US

V. Phone/Fax

Practice location:
  • Phone: 561-921-7258
  • Fax:
Mailing address:
  • Phone: 561-420-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-16-15897
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH008366
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-15897
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: