Provider Demographics
NPI:1619285657
Name:BROWN, JAY E
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CREAMERY DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8011
Mailing Address - Country:US
Mailing Address - Phone:845-569-0054
Mailing Address - Fax:
Practice Address - Street 1:310 WASHINGTON AVENUE
Practice Address - Street 2:CALL BOX A
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477
Practice Address - Country:US
Practice Address - Phone:845-247-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1831443103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool