Provider Demographics
NPI:1174302673
Name:BROWN, STEFANIE (MED, LSSP, NCSP)
Entity type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MED, LSSP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:FT MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:10922-0176
Mailing Address - Country:US
Mailing Address - Phone:972-646-0894
Mailing Address - Fax:
Practice Address - Street 1:2 MARGARETS WAY
Practice Address - Street 2:
Practice Address - City:FT. MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:10922
Practice Address - Country:US
Practice Address - Phone:972-646-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool