Provider Demographics
NPI:1528607439
Name:BROWN, JULIE COLLEEN (PSYD, MAT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:COLLEEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E. COLORADO BLVD.
Mailing Address - Street 2:MEZZANINE LEVEL
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:818-766-7500
Mailing Address - Fax:
Practice Address - Street 1:595 E. COLORADO BLVD.
Practice Address - Street 2:MEZZANINE LEVEL
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:818-766-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94024460103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist