=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568673713
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD JOE BROWN PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2007
-----------------------------------------------------
Last Update Date | 05/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 156 W 56TH ST STE 1804
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-3878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-851-8100
-----------------------------------------------------
Fax | 212-537-0102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 BOULEVARD
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-5218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-472-4369
-----------------------------------------------------
Fax | 914-472-4369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 011880
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 011880
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------