Provider Demographics
NPI:1962483479
Name:BROWN, PATRICIA I M (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:I M
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 1:17713 US HIGHWAY 84-285
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-2668
Mailing Address - Country:US
Mailing Address - Phone:505-455-2268
Mailing Address - Fax:505-455-2122
Practice Address - Street 1:117713 US HWY 84 285
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506
Practice Address - Country:US
Practice Address - Phone:505-455-2268
Practice Address - Fax:505-455-2122
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM150103TC0700X
NM240433103TS0200X
3734103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN08669Medicaid
NMN08669Medicaid