Provider Demographics
NPI:1033896329
Name:BROWN, LAKEYDA DENISE
Entity Type:Individual
Prefix:
First Name:LAKEYDA
Middle Name:DENISE
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 1:128 ILLINIOS ST
Mailing Address - Street 2:3
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-2130
Mailing Address - Country:US
Mailing Address - Phone:125-252-9830
Mailing Address - Fax:
Practice Address - Street 1:10 DORRANCE ST STE 700
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-2014
Practice Address - Country:US
Practice Address - Phone:252-529-8302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00000000101YS0200X
RI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool