MEDICARE: BRAHM L LONG

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	172V00000X	Community Health Worker
2	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1700509718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAHM L LONG

Provider Business Mailing Address
First Line	:	230 W ALAMAR AVE APT 5
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3747
Country	:	US
Telephone Number	:	805-708-8355
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 W ALAMAR AVE APT 5
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3747
Country	:	US
Telephone Number	:	805-708-8355
Fax Number	:

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

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	06/26/2025

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