Provider Demographics
NPI:1619140118
Name:BROWN, NICOLE SUZANNE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SUZANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1811
Mailing Address - Country:US
Mailing Address - Phone:315-472-4471
Mailing Address - Fax:
Practice Address - Street 1:324 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1811
Practice Address - Country:US
Practice Address - Phone:315-472-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health