Provider Demographics
NPI:1053112573
Name:BROWN, EBONI
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:
Last Name:BROWN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 SYDNEY LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7683
Mailing Address - Country:US
Mailing Address - Phone:317-737-5619
Mailing Address - Fax:
Practice Address - Street 1:8125 SYDNEY LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7683
Practice Address - Country:US
Practice Address - Phone:317-737-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst