Provider Demographics
NPI:1962470088
Name:BROWN, FELICIA FAYE (PHD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:FAYE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 NW 76TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6668
Mailing Address - Country:US
Mailing Address - Phone:352-505-6363
Mailing Address - Fax:866-215-3205
Practice Address - Street 1:250 NW 76TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6668
Practice Address - Country:US
Practice Address - Phone:352-505-6363
Practice Address - Fax:866-215-3205
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH979103TB0200X, 103TC0700X
MA7698103TB0200X, 103TC0700X
FLPY9288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA7698OtherMASSACHUSETTS LICENSE
NH30423479Medicaid
FLPY9288OtherFLORIDA LICENSE