Provider Demographics
NPI:1518364066
Name:BROWN, ANTOINE
Entity Type:Individual
Prefix:
First Name:ANTOINE
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 1:770 WOODLANE RD
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-3804
Mailing Address - Country:US
Mailing Address - Phone:609-267-5928
Mailing Address - Fax:
Practice Address - Street 1:1430 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2921
Practice Address - Country:US
Practice Address - Phone:609-434-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health