| Doctor Name: | DR. JACQUELINE B. BROWN |
| NPI Number: | 1659551497 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | PY8006 |
| Business Practice Address: | 1100-1 S. Ponce De Leon Blvd St. Augustine, FL - 32092 |
| Business Phone Number: | 9048247733 |
| Business Fax Number: | 9048299768 |
| Mailing Address: | 1100-1 S. Ponce De Leon Blvd, ST. AUGUSTINE |
| State: | FL |
| Postal Code: | 32092 |
| Phone Number: | 9048247733 |
| Fax Number: | 9048299768 |
| NPI Enumeration Date: | 11/09/2007 |
| NPI Last Update Date: | 01/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | PY8006 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |