Provider Demographics
NPI:1083196455
Name:BROWN, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 FIFTH AVENUE
Mailing Address - Street 2:SUITE 820
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036
Mailing Address - Country:US
Mailing Address - Phone:646-837-8152
Mailing Address - Fax:
Practice Address - Street 1:580 FIFTH AVENUE
Practice Address - Street 2:SUITE 820
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036
Practice Address - Country:US
Practice Address - Phone:646-837-8152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-03
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106822-01104100000X
NY0953821041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical