Healthcare Provider Details

I. General information

NPI: 1508929415
Provider Name (Legal Business Name): DONALD R BRUBAKER L.I.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 W. MARKET STREET
LIMA OH
45805
US

IV. Provider business mailing address

1037 W. MARKET STREET
LIMA OH
45805
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-5077
  • Fax: 419-228-5343
Mailing address:
  • Phone: 419-222-5077
  • Fax: 419-228-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0001120
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: