Provider Demographics
NPI:1316534480
Name:BROWN, CALEB D (MA)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:D
Last Name:BROWN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10337 LINN STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3816
Mailing Address - Country:US
Mailing Address - Phone:502-895-0000
Mailing Address - Fax:
Practice Address - Street 1:10337 LINN STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3816
Practice Address - Country:US
Practice Address - Phone:502-895-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY266421103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY266421OtherKENTUCKY BOARD OF EXAMINERS OF PSYCHOLOGY