Provider Demographics
NPI:1821366287
Name:BROWN, ADDIE LEE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ADDIE
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4032
Mailing Address - Country:US
Mailing Address - Phone:510-909-3866
Mailing Address - Fax:510-479-3420
Practice Address - Street 1:465 34TH ST # 5
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2815
Practice Address - Country:US
Practice Address - Phone:510-909-3866
Practice Address - Fax:510-479-3420
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44663106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2372641Medicaid
CA1821366287OtherLMFT