Provider Demographics
NPI:1396737243
Name:BROWN CABEZUDO, L EMILY (PHD)
Entity type:Individual
Prefix:
First Name:L EMILY
Middle Name:
Last Name:BROWN CABEZUDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MILL RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8947
Mailing Address - Country:US
Mailing Address - Phone:336-707-5871
Mailing Address - Fax:919-988-1042
Practice Address - Street 1:626 N. RIDGE STREET, STE C
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5652
Practice Address - Country:US
Practice Address - Phone:434-334-7143
Practice Address - Fax:480-557-5712
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2017-02-23
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
AZ3576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3648958OtherAETNA PROVIDER NUMBER
AZAZ 0618080OtherBLUE CROSS BLUE SHIELD
AZ700885000OtherMAGELLAN
AZAZ 0618080OtherBLUE CROSS BLUE SHIELD
AZZ85736Medicare PIN