Provider Demographics
NPI:1255493797
Name:BROWN, LEE C (CASAC)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W ONEONTA RD
Mailing Address - Street 2:
Mailing Address - City:OTEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13825-2297
Mailing Address - Country:US
Mailing Address - Phone:607-432-1470
Mailing Address - Fax:
Practice Address - Street 1:127 W ONEONTA RD
Practice Address - Street 2:
Practice Address - City:OTEGO
Practice Address - State:NY
Practice Address - Zip Code:13825-2297
Practice Address - Country:US
Practice Address - Phone:607-432-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21174OtherOASAS