MEDICARE: DR. BARBARA G BREWER PH.D.

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
1	103T00000X	Psychologist	2981	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000012721	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1073735809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA G BREWER PH.D.

Provider Business Mailing Address
First Line	:	2334 ASHLAND AVE.
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206
Country	:	US
Telephone Number	:	513-861-8365
Fax Number	:	513-861-1415

Provider Business Practice Location Address
First Line	:	2334 ASHLAND AVE.
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206
Country	:	US
Telephone Number	:	513-861-8365
Fax Number	:	513-861-1415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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