Provider Demographics
NPI:1033478516
Name:BROWN, ROBERT P (CADAC IV)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:BROWN
Suffix:
Gender:M
Credentials:CADAC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 N TACOMA AVE
Mailing Address - Street 2:INDIANAPOLIS
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3512
Mailing Address - Country:US
Mailing Address - Phone:317-490-5320
Mailing Address - Fax:
Practice Address - Street 1:5555 N TACOMA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3512
Practice Address - Country:US
Practice Address - Phone:317-490-5320
Practice Address - Fax:317-259-7167
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCIV1571101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)