Provider Demographics
NPI:1801885546
Name:BROWN, PERRY E (PHD)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 JAIRUS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5526
Mailing Address - Country:US
Mailing Address - Phone:859-576-8330
Mailing Address - Fax:888-201-8541
Practice Address - Street 1:815 JAIRUS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-5526
Practice Address - Country:US
Practice Address - Phone:859-576-8330
Practice Address - Fax:888-201-8541
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-16
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYR84789Medicare UPIN
KYCP00188Medicare ID - Type Unspecified