Provider Demographics
NPI:1851610646
Name:BROWN, CYNTHIA RUBIN (PSYD, MFT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RUBIN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5808
Mailing Address - Country:US
Mailing Address - Phone:310-453-4854
Mailing Address - Fax:
Practice Address - Street 1:2444 WILSHIRE BLVD
Practice Address - Street 2:SUITE 415
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5808
Practice Address - Country:US
Practice Address - Phone:310-453-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT29762323P00000X, 102L00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist