MEDICARE: MARSHA D BROWN PHD P A

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	103TB0200X	Cognitive & Behavioral Psychologist	PY9675	FL
2	103TC0700X	Clinical Psychologist	PY9675	FL
3	103TF0200X	Forensic Psychologist	PY9675	FL
4	390200000X	Student in an Organized Health Care Education/Training Program
5	103T00000X	Psychologist	PY9675	FL

General Provider Information

NPI Number	:	1477862753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA D BROWN PHD P A

Provider Business Mailing Address
First Line	:	757 SE 17TH ST STE 622
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2960
Country	:	US
Telephone Number	:	917-979-3743
Fax Number	:	954-743-0265

Provider Business Practice Location Address
First Line	:	757 SE 17TH ST STE 622
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2960
Country	:	US
Telephone Number	:	917-979-3743
Fax Number	:	954-743-0265

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

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	08/05/2021

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