Provider Demographics
NPI:1417172073
Name:BROWN, ROBERTA J (BA, CCDC, CAC-AD)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:BA, CCDC, CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LANGLEY RD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6539
Mailing Address - Country:US
Mailing Address - Phone:410-222-0100
Mailing Address - Fax:410-222-0116
Practice Address - Street 1:122 LANGLEY RD N
Practice Address - Street 2:SUITE B
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-6539
Practice Address - Country:US
Practice Address - Phone:410-222-0100
Practice Address - Fax:410-222-0116
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)