Individual provider Active NPI

Sherery Roshelle Brown

  • Adolescent and Children Mental Health Clinic/Center
  • Martinsville, VA
National Provider Identifier
1679081103
Registry record updated Jan 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Practice address
916 Brookdale St Ste 2
Martinsville, VA 24112-3105
Phone
(276) 790-3341
Fax
(276) 790-3167
NPI assigned
Jan 18, 2018
Last updated
Jan 18, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X VA Primary

Addresses

Primary practice location

916 Brookdale St Ste 2
Martinsville, VA 24112-3105

Mailing address

PO Box 3542
Martinsville, VA 24115-3542
Phone (276) 618-4605

Other identifiers 1

IdentifierTypeStateIssuer
0242569520MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Heart Two Heart Rehab Support Services Current Accepting new patients
H2H Transportation Services, LLC Current Accepting new patients
R & E Transportation, LLC Current Accepting new patients

Locations

916 Brookdale St
Ste 2
Martinsville, VA 24112
Phone (276) 790-3341

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516233600000",
    "number": "1679081103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3542",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241153542",
            "telephone_number": "276-618-4605",
            "fax_number": "276-790-3167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 BROOKDALE ST STE 2",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241123105",
            "telephone_number": "276-790-3341",
            "fax_number": "276-790-3167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "SHERERY",
        "middle_name": "ROSHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-18",
        "last_updated": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0242569520",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.