Provider Demographics
NPI:1205119104
Name:BROWN, ROHAN (MA, MDIV, LPC)
Entity type:Individual
Prefix:
First Name:ROHAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MA, MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2234
Mailing Address - Country:US
Mailing Address - Phone:860-202-2057
Mailing Address - Fax:860-513-1002
Practice Address - Street 1:530 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2234
Practice Address - Country:US
Practice Address - Phone:860-202-2057
Practice Address - Fax:860-513-1002
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008001149Medicaid