Provider Demographics
NPI:1770238693
Name:BROWN, ALICE L A
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:L A
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 1:2011 S 25TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4795
Mailing Address - Country:US
Mailing Address - Phone:772-242-1079
Mailing Address - Fax:772-242-1296
Practice Address - Street 1:2011 S 25TH ST STE 108
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4795
Practice Address - Country:US
Practice Address - Phone:772-242-1079
Practice Address - Fax:772-242-1296
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1041C0700XOther1041C0700X