Provider Demographics
NPI:1336524495
Name:BROWN, ANITRA NICOLE (DIPLOMA, CERTIFICATI)
Entity Type:Individual
Prefix:
First Name:ANITRA
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DIPLOMA, CERTIFICATI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 E HADLEY RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3114
Mailing Address - Country:US
Mailing Address - Phone:413-253-3135
Mailing Address - Fax:
Practice Address - Street 1:289 E HADLEY RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-3114
Practice Address - Country:US
Practice Address - Phone:413-253-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 101YA0400X, 103TF0200X, 103TM1800X, 103TP0016X, 103TP0814X, 103TP2701X, 103TR0400X, 106H00000X
ZZ261-4781399103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist