Provider Demographics
NPI:1124996624
Name:BROWN, MATLYN
Entity type:Individual
Prefix:
First Name:MATLYN
Middle Name:
Last Name:BROWN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21109 GARY DR APT 311
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6145
Mailing Address - Country:US
Mailing Address - Phone:510-537-5910
Mailing Address - Fax:
Practice Address - Street 1:21109 GARY DR APT 311
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94546-6145
Practice Address - Country:US
Practice Address - Phone:510-537-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
CA158264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool