Provider Demographics
NPI:1073104519
Name:BROWN, ALIA MARIE HOFF (BA)
Entity Type:Individual
Prefix:MISS
First Name:ALIA
Middle Name:MARIE HOFF
Last Name:BROWN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1011
Mailing Address - Country:US
Mailing Address - Phone:267-974-8198
Mailing Address - Fax:
Practice Address - Street 1:39 GOODING ST APT 2
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-9423
Practice Address - Country:US
Practice Address - Phone:267-974-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty