Provider Demographics
NPI:1952456279
Name:BROWN, LANCE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:5200 DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2304
Mailing Address - Country:US
Mailing Address - Phone:267-250-3648
Mailing Address - Fax:215-232-3151
Practice Address - Street 1:177 MAIN ST
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-4107
Practice Address - Country:US
Practice Address - Phone:609-890-1050
Practice Address - Fax:609-890-0950
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2023-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA015174103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010182180001Medicaid
PA1010182180002Medicaid