Provider Demographics
NPI:1669702932
Name:BROWN, SIDNEY ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:ANN
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:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-1830
Mailing Address - Country:US
Mailing Address - Phone:505-368-1450
Mailing Address - Fax:505-368-1461
Practice Address - Street 1:PINON & COTTONWOOD DR
Practice Address - Street 2:BUILDING #2301
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-368-1450
Practice Address - Fax:505-368-1461
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24174101YA0400X, 101YM0800X
CO4947101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4947Medicaid