Provider Demographics
NPI:1386084523
Name:BROWN, JANESSA
Entity type:Individual
Prefix:DR
First Name:JANESSA
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 1:828 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3879
Mailing Address - Country:US
Mailing Address - Phone:267-277-3012
Mailing Address - Fax:
Practice Address - Street 1:828 N 2ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3879
Practice Address - Country:US
Practice Address - Phone:719-930-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2025-11-12
Deactivation Date:2021-02-15
Deactivation Code:
Reactivation Date:2025-11-06
Provider Licenses
StateLicense IDTaxonomies
PAPS020588103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical