Provider Demographics
NPI:1518341387
Name:BROWN, NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22837 VENTURA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1224
Mailing Address - Country:US
Mailing Address - Phone:310-855-3276
Mailing Address - Fax:
Practice Address - Street 1:22837 VENTURA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1224
Practice Address - Country:US
Practice Address - Phone:310-855-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2012548103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist