Healthcare Provider Details

I. General information

NPI: 1295378370
Provider Name (Legal Business Name): BRAYLIN RUSHTON BSW, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W WOODLAND AVE
YOUNGSTOWN OH
44502-1866
US

IV. Provider business mailing address

569 MOORE DR
CAMPBELL OH
44405-1221
US

V. Phone/Fax

Practice location:
  • Phone: 330-787-9180
  • Fax:
Mailing address:
  • Phone: 724-714-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1904588
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: