Provider Demographics
NPI:1558035303
Name:BROWNE, CHARLES PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PETER
Last Name:BROWNE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:PETER
Other - Last Name:PRESTANO
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:DD
Mailing Address - Street 1:18117 BISCAYNE BLVD STE 61593
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2535
Mailing Address - Country:US
Mailing Address - Phone:904-320-2659
Mailing Address - Fax:
Practice Address - Street 1:4187 LAZY ACRES RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-4915
Practice Address - Country:US
Practice Address - Phone:407-764-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101200000XBehavioral Health & Social Service ProvidersDrama TherapistGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP17032270Medicaid