MEDICARE: MS. CORINNA ANN BROWN LCAT, BC-DMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	225600000X	Dance Therapist	0000208	NY

General Provider Information

NPI Number	:	1174172936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CORINNA ANN BROWN LCAT, BC-DMT

Provider Business Mailing Address
First Line	:	105 LEXINGTON AVE APT 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-1762
Country	:	US
Telephone Number	:	917-664-8230
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 W 27TH ST STE 402
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-6241
Country	:	US
Telephone Number	:	917-664-8230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	09/05/2019

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