MEDICARE: CYNTHIA RUBIN BROWN PSYD, MFT

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	323P00000X	Psychiatric Residential Treatment Facility	MFT29762	CA
2	102L00000X	Psychoanalyst	MFT29762	CA
3	106H00000X	Marriage & Family Therapist	MFT29762	CA

General Provider Information

NPI Number	:	1851610646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA RUBIN BROWN PSYD, MFT

Provider Business Mailing Address
First Line	:	2444 WILSHIRE BLVD
Second Line	:	SUITE 415
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5808
Country	:	US
Telephone Number	:	310-453-4854
Fax Number	:

Provider Business Practice Location Address
First Line	:	2444 WILSHIRE BLVD
Second Line	:	SUITE 415
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5808
Country	:	US
Telephone Number	:	310-453-4854
Fax Number	:

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

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	09/30/2010

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