Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 4877 | NJ |
N | 103T00000X | Psychologist | 4877 | NJ |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 018451 | NY |
NPI | 1093102634 |
---|---|
Provider Name | Dr. William Brown |
First Address | Far Rockaway, NY 11691-4835 |
Second Address | Far Rockaway, NY 11691-4835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 21/04/2015 |