MEDICARE: DR. SPENCER P BROWN PSY.D, LPC

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	101YP2500X	Professional Counselor	PC010213	PA
2	103TC0700X	Clinical Psychologist	B1-0011447	DE

General Provider Information

NPI Number	:	1861172116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SPENCER P BROWN PSY.D, LPC

Provider Business Mailing Address
First Line	:	902 VALLEY RD APT 11C
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-3237
Country	:	US
Telephone Number	:	267-303-4033
Fax Number	:

Provider Business Practice Location Address
First Line	:	4755 OGLETOWN STANTON RD STE 1900
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19718-3237
Country	:	US
Telephone Number	:	302-733-6662
Fax Number	:	302-733-2372

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

Provider Enumeration Date	:	07/21/2023
Last Update Date	:	02/03/2024

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