Provider Demographics
NPI:1841212149
Name:BROWN, JUDITH R (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:R.
Other - Middle Name:JUDITH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:39812 MISSION BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3056
Mailing Address - Country:US
Mailing Address - Phone:510-793-9840
Mailing Address - Fax:510-353-1375
Practice Address - Street 1:39812 MISSION BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3056
Practice Address - Country:US
Practice Address - Phone:510-793-9840
Practice Address - Fax:510-353-1375
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8747103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL87470Medicare PIN
CAR75261Medicare UPIN