Provider Demographics
NPI:1811545999
Name:BROWN, ISHMAEL SAMUEL (MA)
Entity Type:Individual
Prefix:MR
First Name:ISHMAEL
Middle Name:SAMUEL
Last Name:BROWN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7374 WEST BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5226
Mailing Address - Country:US
Mailing Address - Phone:267-647-8158
Mailing Address - Fax:
Practice Address - Street 1:2111 BELMONT AVE STE 5
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2428
Practice Address - Country:US
Practice Address - Phone:330-744-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional