Provider Demographics
NPI:1174878565
Name:BROWN, CHRYSTAL
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 WICKERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4542
Mailing Address - Country:US
Mailing Address - Phone:407-758-0901
Mailing Address - Fax:
Practice Address - Street 1:1086 WICKERWOOD ST
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4542
Practice Address - Country:US
Practice Address - Phone:407-758-0901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-21
Last Update Date:2012-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker