MEDICARE: CHARLES DANIEL BROWN PH.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	103TC2200X	Clinical Child & Adolescent Psychologist	PY 2853 PR	MA
2	103T00000X	Psychologist	PY 2853 PR	MA
3	103TS0200X	School Psychologist		MA

General Provider Information

NPI Number	:	1609860881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES DANIEL BROWN PH.D.

Provider Business Mailing Address
First Line	:	312 WOODCLIFF RD
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02461-2128
Country	:	US
Telephone Number	:	617-244-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 WOODCLIFF RD
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02461-2128
Country	:	US
Telephone Number	:	617-244-9197
Fax Number	:

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	09/11/2025

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