MEDICARE: MRS. IRENE S. BROWN M.A., LMFT

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	106H00000X	Marriage & Family Therapist	78440	CA

General Provider Information

NPI Number	:	1730547720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IRENE S. BROWN M.A., LMFT

Provider Business Mailing Address
First Line	:	4195 CHINO HILLS PKWY # 1106
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-2618
Country	:	US
Telephone Number	:	909-342-2219
Fax Number	:

Provider Business Practice Location Address
First Line	:	4195 CHINO HILLS PKWY # 1106
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-2618
Country	:	US
Telephone Number	:	909-342-2219
Fax Number	:

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

Provider Enumeration Date	:	02/04/2016
Last Update Date	:	08/08/2020

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