Healthcare Provider Details

I. General information

NPI: 1003508532
Provider Name (Legal Business Name): MADISON BREWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 PROSPECT AVE E
CLEVELAND OH
44115-2704
US

IV. Provider business mailing address

3622 PROSPECT AVE E
CLEVELAND OH
44115-2704
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-4600
  • Fax:
Mailing address:
  • Phone: 216-431-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607221
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: