Provider Demographics
NPI:1376255422
Name:BROWN, DEANNA IVELLISE (MHC-LP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:IVELLISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SPRING ST APT 203
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-2923
Mailing Address - Country:US
Mailing Address - Phone:973-592-2687
Mailing Address - Fax:
Practice Address - Street 1:2815 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1237
Practice Address - Country:US
Practice Address - Phone:718-801-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP08749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health