Basic Information
| Provider Information | |||||||||
| NPI: | 1588088546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | D C | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1512 MANOR AVE | ||||||||
| Address2: | |||||||||
| City: | MCKEESPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151324719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127706208 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 WEST ST | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151202563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124644781 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 02/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP1600X | N | Behavioral Health & Social Service Providers | Counselor | Pastoral |
No ID Information.