MEDICARE: DEBBIE BRADY DUKES 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	1284C	AL

General Provider Information

NPI Number	:	1316269236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE BRADY DUKES LCSW

Provider Business Mailing Address
First Line	:	530 SHANNON LYNN SHRS
Second Line	:
City	:	TALLADEGA
State	:	AL
Zip	:	35160-8408
Country	:	US
Telephone Number	:	256-268-0408
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 BATTLE ST E
Second Line	:
City	:	TALLADEGA
State	:	AL
Zip	:	35160-2420
Country	:	US
Telephone Number	:	256-362-9677
Fax Number	:

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

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	02/18/2010

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