Provider Demographics
NPI:1316027873
Name:SHARON D BROWN, PSY.D., LLC
Entity Type:Organization
Organization Name:SHARON D BROWN, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:937-236-1331
Mailing Address - Street 1:1250 W DOROTHY LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1317
Mailing Address - Country:US
Mailing Address - Phone:937-294-6612
Mailing Address - Fax:937-236-0661
Practice Address - Street 1:1250 W DOROTHY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1317
Practice Address - Country:US
Practice Address - Phone:937-294-6612
Practice Address - Fax:937-236-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========-00OtherOHIO B.W.C. GROUP P.I.N.
OHSH9355241Medicare ID - Type UnspecifiedGROUP P.I.N.