Provider Demographics
NPI:1053904466
Name:BROWN, LYNNELL (LADC)
Entity type:Individual
Prefix:
First Name:LYNNELL
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HILLSIDE ST APT A3
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3630
Mailing Address - Country:US
Mailing Address - Phone:860-997-0851
Mailing Address - Fax:
Practice Address - Street 1:50 HILLSIDE ST APT A3
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3630
Practice Address - Country:US
Practice Address - Phone:860-997-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001366101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty