Provider Demographics
NPI:1134518624
Name:BROWN, KRISTOPHER (PSYD, BCBA-D, LP)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PSYD, BCBA-D, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5286 S SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4076
Mailing Address - Country:US
Mailing Address - Phone:330-257-5330
Mailing Address - Fax:
Practice Address - Street 1:5500 MARKET ST STE 119
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2616
Practice Address - Country:US
Practice Address - Phone:330-991-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
OHP.08535103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst