Provider Demographics
NPI:1548399892
Name:BROWN, ERIC L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:BROWN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LENOX ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-3014
Mailing Address - Country:US
Mailing Address - Phone:617-527-2417
Mailing Address - Fax:617-527-2412
Practice Address - Street 1:50 ADAMS ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1461
Practice Address - Country:US
Practice Address - Phone:617-965-4090
Practice Address - Fax:617-965-0417
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3360103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03422Medicare ID - Type Unspecified