Provider Demographics
NPI:1023155090
Name:BROWN, PATRICIA JANE (PHD MFT LAC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JANE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD MFT LAC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:TUTTLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD MFT LAC
Mailing Address - Street 1:513 PETALUMA BLVD SOUTH
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5128
Mailing Address - Country:US
Mailing Address - Phone:707-762-2240
Mailing Address - Fax:707-762-9290
Practice Address - Street 1:513 PETALUMA BLVD SOUTH
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5128
Practice Address - Country:US
Practice Address - Phone:707-762-2240
Practice Address - Fax:707-762-9290
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC12131106H00000X
CAAC3234171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0032340Medicaid