Provider Demographics
NPI:1760118756
Name:BROWN, COURTNEY ELYSE (RBT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELYSE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 13TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2729
Mailing Address - Country:US
Mailing Address - Phone:301-972-2002
Mailing Address - Fax:
Practice Address - Street 1:8230 LEESBURG PIKE STE 740
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2641
Practice Address - Country:US
Practice Address - Phone:187-750-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBACB279019106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician