Provider Demographics
NPI:1558622613
Name:BROWN, CAROL DENISE (MS, SPED)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:DENISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 2ND AVE
Mailing Address - Street 2:APT # 8J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5326
Mailing Address - Country:US
Mailing Address - Phone:917-279-7204
Mailing Address - Fax:
Practice Address - Street 1:1763 2ND AVE
Practice Address - Street 2:APT # 8J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5326
Practice Address - Country:US
Practice Address - Phone:917-279-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist