Provider Demographics
NPI:1548792542
Name:BROWN, NICOLETTE (MT-BC)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-6590
Mailing Address - Country:US
Mailing Address - Phone:727-364-9479
Mailing Address - Fax:
Practice Address - Street 1:5315 COCHRAN ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-6590
Practice Address - Country:US
Practice Address - Phone:727-364-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health