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NPI Code Detail

MEDICARE: BRIANA MARIE PADGETT PSY S

MEDICARE:   BRIANA MARIE PADGETT  PSY S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist

General Provider Information

NPI Number : 1073104311
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANA MARIE PADGETT PSY S
Provider Business Mailing Address
First Line : 5705 FARRELL RD
Second Line :
City : CENTRAL LAKE
State : MI
Zip : 49622-9705
Country : US
Telephone Number : 517-490-7154
Fax Number :
Provider Business Practice Location Address
First Line : 5705 FARRELL RD
Second Line :
City : CENTRAL LAKE
State : MI
Zip : 49622-9705
Country : US
Telephone Number : 517-490-7154
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2021
Last Update Date : 01/29/2021

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Directions to “ BRIANA MARIE PADGETT PSY S” Practice Location

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