MEDICARE: BYRAN LEE LCADC

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	LCA3126	MD

General Provider Information

NPI Number	:	1902562614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYRAN LEE LCADC

Provider Business Mailing Address
First Line	:	2530 MARYLAND AVE APT 2F
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4546
Country	:	US
Telephone Number	:	443-602-5373
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 FALLS RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21211-1844
Country	:	US
Telephone Number	:	410-204-1983
Fax Number	:

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

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	11/27/2024

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