Provider Demographics
NPI:1922759133
Name:BROWN, DAVID EDWARD (MA MFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18422 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6048
Mailing Address - Country:US
Mailing Address - Phone:657-224-0081
Mailing Address - Fax:
Practice Address - Street 1:18422 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6048
Practice Address - Country:US
Practice Address - Phone:657-224-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health