Provider Demographics
NPI:1831709773
Name:BROWN, CARROLL TAYLOR III (PMHNP)
Entity type:Individual
Prefix:MR
First Name:CARROLL
Middle Name:TAYLOR
Last Name:BROWN
Suffix:III
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:468 STOW AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1159
Mailing Address - Country:US
Mailing Address - Phone:510-934-2805
Mailing Address - Fax:
Practice Address - Street 1:652 PETALUMA AVE STE H
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4266
Practice Address - Country:US
Practice Address - Phone:707-823-3166
Practice Address - Fax:707-869-8170
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95202301163WP0807X
CA95018200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent