Provider Demographics
NPI:1649893033
Name:BROWN, REBECCA MJ (PSYD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MJ
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720G RITCHIE HWY # 250
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2319
Mailing Address - Country:US
Mailing Address - Phone:818-497-6703
Mailing Address - Fax:
Practice Address - Street 1:6720G RITCHIE HWY # 250
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2319
Practice Address - Country:US
Practice Address - Phone:818-497-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY200001268103TC0700X
133N00000X, 171400000X, 175F00000X, 390200000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No171400000XOther Service ProvidersHealth & Wellness Coach
No175F00000XOther Service ProvidersNaturopath
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program