MEDICARE: BRANDI LEE LABARRE

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

General Provider Information

NPI Number	:	1265100846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI LEE LABARRE

Provider Business Mailing Address
First Line	:	124 ELK LN
Second Line	:
City	:	SAYLORSBURG
State	:	PA
Zip	:	18353-7703
Country	:	US
Telephone Number	:	484-353-8972
Fax Number	:

Provider Business Practice Location Address
First Line	:	5221 MILFORD RD
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18302-9149
Country	:	US
Telephone Number	:	570-422-6522
Fax Number	:

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

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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