Provider Demographics
NPI:1487065314
Name:BROWN, MICHELLE LYNN (PHD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:216 FLORAL PKWY
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3439
Mailing Address - Country:US
Mailing Address - Phone:914-438-4989
Mailing Address - Fax:516-873-8881
Practice Address - Street 1:1225 FRANKLIN AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1691
Practice Address - Country:US
Practice Address - Phone:516-873-8880
Practice Address - Fax:516-873-8881
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY020378103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical