Provider Demographics
NPI:1215357165
Name:BROWN, BETTYNA (MA, EDS, LPC)
Entity Type:Individual
Prefix:
First Name:BETTYNA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 LAMBERTON ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-2911
Mailing Address - Country:US
Mailing Address - Phone:609-222-0641
Mailing Address - Fax:
Practice Address - Street 1:212 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:NJ
Practice Address - Zip Code:08049-1409
Practice Address - Country:US
Practice Address - Phone:856-361-2720
Practice Address - Fax:856-309-9716
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00487400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health