Healthcare Provider Details

I. General information

NPI: 1487904918
Provider Name (Legal Business Name): JOCELYN JOY BROWN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOCELYN JOY BURUM PSYD

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PENNSYLVANIA AVE
CHARLESTON WV
25302-3351
US

IV. Provider business mailing address

800 PENNSYLVANIA AVENUE CAMC FAMILY RESOURCE CENTER
CHARLESTON WV
25302
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-2525
  • Fax: 304-388-2781
Mailing address:
  • Phone: 304-388-2525
  • Fax: 304-388-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1085
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: