Provider Demographics
NPI:1205312717
Name:BROWN, DEZRAIA
Entity type:Individual
Prefix:
First Name:DEZRAIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5585
Mailing Address - Country:US
Mailing Address - Phone:845-849-6619
Mailing Address - Fax:
Practice Address - Street 1:35 BAKER RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-5585
Practice Address - Country:US
Practice Address - Phone:845-849-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency