Provider Demographics
NPI:1407258841
Name:BROWN, MARCUS
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
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 1:3105 E JEFFERSON ST
Mailing Address - Street 2:APT. A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6434
Mailing Address - Country:US
Mailing Address - Phone:407-413-3231
Mailing Address - Fax:
Practice Address - Street 1:3105 E JEFFERSON ST
Practice Address - Street 2:APT. A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-6434
Practice Address - Country:US
Practice Address - Phone:407-413-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst