Provider Demographics
NPI:1639611817
Name:BROWN, JERICKA (MS)
Entity type:Individual
Prefix:
First Name:JERICKA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 MOUNT HOLLY RD APT P4
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-2233
Mailing Address - Country:US
Mailing Address - Phone:609-676-0112
Mailing Address - Fax:609-265-9268
Practice Address - Street 1:1475 MOUNT HOLLY RD APT P4
Practice Address - Street 2:
Practice Address - City:EDGEWATER PARK
Practice Address - State:NJ
Practice Address - Zip Code:08010-2233
Practice Address - Country:US
Practice Address - Phone:609-676-0112
Practice Address - Fax:609-265-9268
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-05
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00895200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional