MEDICARE: JIM BRACE LCSW

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	104100000X	Social Worker	SW7075	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW7075	OTHER	FL	SOCIAL WORKER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184788705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM BRACE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 4772
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33677-4772
Country	:	US
Telephone Number	:	813-247-5433
Fax Number	:	813-248-2141

Provider Business Practice Location Address
First Line	:	209 N WILLOW AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1333
Country	:	US
Telephone Number	:	813-247-5433
Fax Number	:	813-248-2141

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/09/2007

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Directions to “ JIM BRACE LCSW” Practice Location

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