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NPI Code Detail

MEDICARE: BRANDY TAYLOR LISW, LICDC

MEDICARE: BRANDY TAYLOR LISW, LICDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.162555OH
21041C0700XClinical Social WorkerI.2304983OH

General Provider Information

NPI Number : 1023592268
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY TAYLOR LISW, LICDC
Provider Business Mailing Address
First Line : 4930 KOLMAR AVE
Second Line :
City : DAYTON
State : OH
Zip : 45432-3127
Country : US
Telephone Number : 937-715-2185
Fax Number :
Provider Business Practice Location Address
First Line : 1628 SPRINGFIELD ST
Second Line :
City : DAYTON
State : OH
Zip : 45403-1430
Country : US
Telephone Number : 937-802-5440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2018
Last Update Date : 12/27/2023

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