Provider Demographics
NPI:1508290123
Name:BROWN, DANIEL CALVIN (MA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:CALVIN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PRESCOTT ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3630
Mailing Address - Country:US
Mailing Address - Phone:339-203-1794
Mailing Address - Fax:
Practice Address - Street 1:25R MARKET ST
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2212
Practice Address - Country:US
Practice Address - Phone:978-356-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health