=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194303388
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNETTE PAULA BROWN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2021
-----------------------------------------------------
Last Update Date | 03/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11929 80TH RD
-----------------------------------------------------
City | KEW GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11415-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-362-0615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18730 119TH DR
-----------------------------------------------------
City | SAINT ALBANS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11412-3602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-382-5825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 002536
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------