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NPI Code Detail

MEDICARE: BRYCE BORON CT

MEDICARE: BRYCE BORON CT
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
1101YM0800XMental Health CounselorC.2405802-TRNEOH

General Provider Information

NPI Number : 1316778962
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYCE BORON CT
Provider Business Mailing Address
First Line : 20435 KELSEY LN
Second Line :
City : STRONGSVILLE
State : OH
Zip : 44149-0967
Country : US
Telephone Number : 440-596-1411
Fax Number :
Provider Business Practice Location Address
First Line : 4983 RIDGE RD STE A
Second Line :
City : WADSWORTH
State : OH
Zip : 44281-9738
Country : US
Telephone Number : 440-596-1411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2024
Last Update Date : 06/10/2025

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