Provider Demographics
NPI:1457524886
Name:BROWN, CORRINA EDE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CORRINA
Middle Name:EDE
Last Name:BROWN
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 1:727 N BROADWAY
Mailing Address - Street 2:SUITE A2
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2348
Mailing Address - Country:US
Mailing Address - Phone:516-319-4202
Mailing Address - Fax:
Practice Address - Street 1:727 N BROADWAY
Practice Address - Street 2:SUITE A2
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2348
Practice Address - Country:US
Practice Address - Phone:516-319-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017573103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical