MEDICARE: DR. VIKKI L BROWN ED.D.

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	103T00000X	Psychologist	6495	MA
2	103TA0700X	Adult Development & Aging Psychologist	6495	MA
3	103TB0200X	Cognitive & Behavioral Psychologist	6495	MA
4	103TC0700X	Clinical Psychologist	6495	MA
5	103TH0004X	Health Psychologist	6495	MA
6	103TH0100X	Health Service Psychologist	6495	MA

General Provider Information

NPI Number	:	1447315049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIKKI L BROWN ED.D.

Provider Business Mailing Address
First Line	:	872 MASSACHUSETTS AVE
Second Line	:	STE 2-1
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3072
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	872 MASSACHUSETTS AVE
Second Line	:	STE 2-1
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3072
Country	:	US
Telephone Number	:	617-661-1688
Fax Number	:

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	04/01/2016

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