Provider Demographics
NPI:1114918885
Name:BROWN, LEWIS MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:MICHAEL
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LEW
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 170297
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-0297
Mailing Address - Country:US
Mailing Address - Phone:718-834-1646
Mailing Address - Fax:718-834-1323
Practice Address - Street 1:68 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1945
Practice Address - Country:US
Practice Address - Phone:718-834-1646
Practice Address - Fax:718-834-1323
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09119-1103T00000X
NC1076103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01444128Medicaid
NY01444128Medicaid