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General NPI Number Information
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NPI Number | 1962746008
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Entity Type | Individual
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Provider Name | BRION L. KING MSSA
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Gender | Male
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 2173 N RIDGE RD E
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City | LORAIN
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State | OH
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Zip | 44055-3400
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Country | US
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Telephone | 440-213-5682
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Fax | 440-282-3400
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Provider Business Mailing Address
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Address Line | 202 E BAGLEY RD
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City | BEREA
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State | OH
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Zip | 44017-2058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S-0600832
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License Number State | OH
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