Basic Information
| Provider Information | |||||||||
| NPI: | 1750442414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | BA JD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 WALTHAM STREET | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024218033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818623600 | ||||||||
| FaxNumber: | 7818607636 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 WALTHAM STREET | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024218033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818623600 | ||||||||
| FaxNumber: | 7818607636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 1303287 | 01 | MA | MBHP | OTHER | M18633 | 01 | MA | BCBC | OTHER | 1303287 | 05 | MA | MEDICAID | 703136 | 05 | MA | MEDICAID | NP01332 | 01 | MA | BMC | OTHER |