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NPI Code Detail

MEDICARE: JEREMY BROWN CDCA.168661

MEDICARE: JEREMY BROWN CDCA.168661
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.168661OH
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.165134OH
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1104273424
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY BROWN CDCA.168661
Provider Business Mailing Address
First Line : PO BOX 3095
Second Line :
City : DUBLIN
State : OH
Zip : 43016-0046
Country : US
Telephone Number : 740-357-8615
Fax Number :
Provider Business Practice Location Address
First Line : 419 VERNON ST
Second Line :
City : IRONTON
State : OH
Zip : 45638-1637
Country : US
Telephone Number : 740-357-8615
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2016
Last Update Date : 01/10/2023

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