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NPI Code Detail

MEDICARE: CORINNE BRAGLIN LCDCIII

MEDICARE: CORINNE BRAGLIN LCDCIII
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) CounselorLCDCIII.161387OH

General Provider Information

NPI Number : 1174038731
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORINNE BRAGLIN LCDCIII
Provider Business Mailing Address
First Line : 227 N MAIN ST
Second Line :
City : NEW LEXINGTON
State : OH
Zip : 43764-1264
Country : US
Telephone Number : 740-342-1991
Fax Number : 740-342-2992
Provider Business Practice Location Address
First Line : 227 N MAIN ST
Second Line :
City : NEW LEXINGTON
State : OH
Zip : 43764-1264
Country : US
Telephone Number : 740-342-1991
Fax Number : 740-342-2992
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2017
Last Update Date : 12/05/2017

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