Provider Demographics
NPI:1760893796
Name:BROWN, KAITLYN
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
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 1:390 WATERLOO BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 WATERLOO BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2603
Practice Address - Country:US
Practice Address - Phone:610-363-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000711101YM0800X
PAPC007322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health