=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528607439
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE COLLEEN BROWN PSYD, MAT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2019
-----------------------------------------------------
Last Update Date | 12/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 595 E. COLORADO BLVD. MEZZANINE LEVEL
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-766-7500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 595 E. COLORADO BLVD. MEZZANINE LEVEL
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-766-7500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSB94024460
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------