MEDICARE: MR. BRENDON RICHEY

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1568814457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRENDON RICHEY

Provider Business Mailing Address
First Line	:	3435 SUPERIOR PARK DR
Second Line	:	APT 202
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2146
Country	:	US
Telephone Number	:	513-544-7547
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 SUPERIOR PARK DR
Second Line	:	APT 202
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2146
Country	:	US
Telephone Number	:	513-544-7547
Fax Number	:

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

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	07/05/2016

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Directions to “ MR. BRENDON RICHEY ” Practice Location

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