=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285444133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARISSE ANN BROWN LCAT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 692 SAW MILL RIVER RD
-----------------------------------------------------
City | ARDSLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10502-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-552-1335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 N BROADWAY APT 5L
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10601-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-552-1335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101200000X
-----------------------------------------------------
Taxonomy Name | Drama Therapist
-----------------------------------------------------
License Number | 002034-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------