Provider Demographics
NPI:1053054403
Name:BROWN, JENNIFER ELISA (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELISA
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 CHAMBERS LN UNIT 8
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-4263
Mailing Address - Country:US
Mailing Address - Phone:404-578-1730
Mailing Address - Fax:
Practice Address - Street 1:3728 CHAMBERS LN UNIT 8
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-4263
Practice Address - Country:US
Practice Address - Phone:404-578-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health