Provider Demographics
NPI:1477862753
Name:BROWN, MARSHA D (PHD P A)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD P A
Other - Prefix:DR
Other - First Name:MARSHA
Other - Middle Name:D
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD P A
Mailing Address - Street 1:757 SE 17TH ST STE 622
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2960
Mailing Address - Country:US
Mailing Address - Phone:917-979-3743
Mailing Address - Fax:954-743-0265
Practice Address - Street 1:757 SE 17TH ST STE 622
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2960
Practice Address - Country:US
Practice Address - Phone:917-979-3743
Practice Address - Fax:954-743-0265
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9675103TB0200X, 103TC0700X, 103TF0200X, 103T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program