Provider Demographics
NPI:1235140963
Name:BROWN JONES, ABIGAIL (MS, MFT)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:
Last Name:BROWN JONES
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:MS
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:2255 MARSH HARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4071
Mailing Address - Country:US
Mailing Address - Phone:702-290-7653
Mailing Address - Fax:702-290-7653
Practice Address - Street 1:2255 MARSH HARBOR AVE
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4071
Practice Address - Country:US
Practice Address - Phone:702-290-7653
Practice Address - Fax:702-290-7653
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 3090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1235140963Medicaid
N/AOtherN/A