Provider Demographics
NPI:1043691975
Name:LIDDI BROWN, DEBORAH (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:LIDDI BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LEE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1844 N MAR VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-1326
Mailing Address - Country:US
Mailing Address - Phone:626-826-2008
Mailing Address - Fax:
Practice Address - Street 1:446 S MARENGO AVE STE B
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3113
Practice Address - Country:US
Practice Address - Phone:626-744-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15107103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist