Provider Demographics
NPI:1013115401
Name:BROWN, RONALD JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:82 COLUMBIA ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6357
Mailing Address - Country:US
Mailing Address - Phone:207-942-8200
Mailing Address - Fax:207-990-3065
Practice Address - Street 1:82 COLUMBIA ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6357
Practice Address - Country:US
Practice Address - Phone:207-942-8200
Practice Address - Fax:207-990-3065
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPSY642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical