Provider Demographics
NPI:1275694986
Name:BROWN, DOROTHY B (PHD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:B
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:B
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2128 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878
Mailing Address - Country:US
Mailing Address - Phone:401-624-9972
Mailing Address - Fax:401-624-1452
Practice Address - Street 1:2128 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878
Practice Address - Country:US
Practice Address - Phone:401-624-9972
Practice Address - Fax:401-624-1452
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI377103T00000X
MA4612103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABRWO4553OtherBLUE CROSS
RIRIBC93374OtherBLUE CROSS
RIRIBC93374OtherBLUE CROSS