Provider Demographics
NPI:1457894990
Name:BROWN, JOHN L (PHD, BCBA-D, LBA)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD, BCBA-D, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2794 LANTANA LAKES DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4621
Mailing Address - Country:US
Mailing Address - Phone:201-362-3098
Mailing Address - Fax:
Practice Address - Street 1:2794 LANTANA LAKES DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4621
Practice Address - Country:US
Practice Address - Phone:201-362-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000001103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst