Provider Demographics
NPI:1487973129
Name:BROWN, BRAD ALLEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 CAMPUS DR APT 2
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3613
Mailing Address - Country:US
Mailing Address - Phone:417-827-9552
Mailing Address - Fax:
Practice Address - Street 1:340 CAMPUS DR APT 2
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-3613
Practice Address - Country:US
Practice Address - Phone:417-827-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist