Provider Demographics
NPI:1700964459
Name:BROWN, HAZEL J (DED)
Entity Type:Individual
Prefix:DR
First Name:HAZEL
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:DED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 SAINT JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1333
Mailing Address - Country:US
Mailing Address - Phone:717-737-8864
Mailing Address - Fax:717-737-5291
Practice Address - Street 1:545 SAINT JOHNS DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1333
Practice Address - Country:US
Practice Address - Phone:717-737-8864
Practice Address - Fax:717-737-5291
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000701L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30274OtherBLUE SHIELD
PA02436600OtherCAPITAL BLUE CROSS
PAR05644Medicare UPIN
PA030274Medicare ID - Type Unspecified