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General NPI Number Information
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NPI Number | 1952456279
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Entity Type | Individual
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Provider Name | LANCE A BROWN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 177 MAIN ST
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City | MATAWAN
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State | NJ
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Zip | 07747-4107
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Country | US
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Telephone | 609-890-1050
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Fax | 609-890-0950
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Provider Business Mailing Address
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Address Line | 5200 DIAMOND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2304
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Country | US
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Telephone | 267-250-3648
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Fax | 215-232-3151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 015174
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License Number State | PA
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