Provider Demographics
NPI:1881906261
Name:BROWN, PETER ALLEN (PSYD, MA)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:PSYD, MA
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 6892
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0351
Mailing Address - Country:US
Mailing Address - Phone:415-375-0096
Mailing Address - Fax:
Practice Address - Street 1:550 H ST STE 5N
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3737
Practice Address - Country:US
Practice Address - Phone:415-375-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26174102L00000X, 102L00000X
CA26174103TP0814X
CAPSY#26174103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical