Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY 6923 | FL |
N | 103TC0700X | Clinical Psychologist | PY 6923 | FL |
N | 103TA0700X | Adult Development & Aging Psychologist | PY 6923 | FL |
NPI | 1144261751 |
---|---|
Provider Name | Dr. Lisa M Brown |
First Address | Odessa, FL 33556-1711 |
Second Address | Tampa, FL 33612-3807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |