Healthcare Provider Details

I. General information

NPI: 1659579837
Provider Name (Legal Business Name): BRYAN JAMES MEADE LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S LINCOLN AVE
LEBANON PA
17042-7529
US

IV. Provider business mailing address

1700 S LINCOLN AVE
LEBANON PA
17042-7529
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-6621
  • Fax: 717-228-6164
Mailing address:
  • Phone: 717-272-6621
  • Fax: 717-228-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW125188
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: