MEDICARE: DAJANAE MONIQUE BRINSON

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1689342917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAJANAE MONIQUE BRINSON

Provider Business Mailing Address
First Line	:	11 W MONUMENT AVE FL 7
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-1274
Country	:	US
Telephone Number	:	937-461-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 E MAIN ST
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-2411
Country	:	US
Telephone Number	:	937-854-0210
Fax Number	:

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

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	09/01/2021

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Directions to “ DAJANAE MONIQUE BRINSON ” Practice Location

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