MEDICARE: JULIE H BRICKING LISW, LICDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	964490	OH
2	1041C0700X	Clinical Social Worker	I.0002010	OH

General Provider Information

NPI Number	:	1487989463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE H BRICKING LISW, LICDC

Provider Business Mailing Address
First Line	:	2600 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1711
Country	:	US
Telephone Number	:	513-751-7747
Fax Number	:	513-872-5182

Provider Business Practice Location Address
First Line	:	3131 HARVEY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3000
Country	:	US
Telephone Number	:	513-861-0035
Fax Number	:	513-872-5182

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

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	10/09/2009

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