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NPI Code Detail

MEDICARE: KRYSTLE BROWN PSYD

MEDICARE:   KRYSTLE  BROWN  PSYD
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
1101YM0800XMental Health Counselor
2103TC0700XClinical Psychologist11658MA
3103TC0700XClinical PsychologistPSY-005326AZ

General Provider Information

NPI Number : 1326399890
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTLE BROWN PSYD
Provider Business Mailing Address
First Line : 42 PATTON RD
Second Line :
City : AYER
State : MA
Zip : 01434-3802
Country : US
Telephone Number : 617-719-7329
Fax Number :
Provider Business Practice Location Address
First Line : 291 HAMILTON ST
Second Line :
City : WORCESTER
State : MA
Zip : 01604-2228
Country : US
Telephone Number : 617-719-7329
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2012
Last Update Date : 12/05/2021

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