Provider Demographics
NPI:1376712042
Name:BROWN, RICHARD JOSEPH
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 W OLIVE AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1959
Mailing Address - Country:US
Mailing Address - Phone:209-725-2125
Mailing Address - Fax:209-384-1495
Practice Address - Street 1:1170 W OLIVE AVE
Practice Address - Street 2:SUITE G
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1959
Practice Address - Country:US
Practice Address - Phone:209-725-2125
Practice Address - Fax:209-384-1495
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS17456101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health