Provider Demographics
NPI:1912276437
Name:BROWN, TANYA TAWONE (BA, CASAC)
Entity Type:Individual
Prefix:MR
First Name:TANYA
Middle Name:TAWONE
Last Name:BROWN
Suffix:
Gender:F
Credentials:BA, CASAC
Other - Prefix:MR
Other - First Name:TANYA
Other - Middle Name:TAWONE
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA,CASAC
Mailing Address - Street 1:36 HATFIELD PL
Mailing Address - Street 2:UPPER
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2129
Mailing Address - Country:US
Mailing Address - Phone:718-226-2537
Mailing Address - Fax:718-226-2998
Practice Address - Street 1:36 HATFIELD PL
Practice Address - Street 2:UPPER
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302
Practice Address - Country:US
Practice Address - Phone:718-226-2537
Practice Address - Fax:718-226-2998
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional