MEDICARE: SA'DERIA NACHET 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	1041C0700X	Clinical Social Worker	0904012538	VA

General Provider Information

NPI Number	:	1265029029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SA'DERIA NACHET BRACE LCSW

Provider Business Mailing Address
First Line	:	3634 S PLAZA TRL STE 204
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-3351
Country	:	US
Telephone Number	:	757-774-3379
Fax Number	:

Provider Business Practice Location Address
First Line	:	3634 S PLAZA TRL STE 204
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-3351
Country	:	US
Telephone Number	:	757-774-3379
Fax Number	:

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

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	01/23/2021

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