MEDICARE: IDA MARIE HEBRANK LADC LIMHP CMSW

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	679	NE
2	101YM0800X	Mental Health Counselor	884	NE
3	1041C0700X	Clinical Social Worker	1297	NE

General Provider Information

NPI Number	:	1144387267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDA MARIE HEBRANK LADC LIMHP CMSW

Provider Business Mailing Address
First Line	:	8715 OAK ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3051
Country	:	US
Telephone Number	:	402-333-0898
Fax Number	:	402-333-0988

Provider Business Practice Location Address
First Line	:	8715 OAK ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3051
Country	:	US
Telephone Number	:	402-333-0898
Fax Number	:	402-333-0988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	01/30/2012

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