MEDICARE: DAYBREAK THERAPY SOLUTIONS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12747	OTHER	LA	LOUISIANA STATE BOARD SOCIAL WORK EXAMINERS
2	1477031524	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1801354337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYBREAK THERAPY SOLUTIONS

Provider Business Mailing Address
First Line	:	14641 STONEBERG AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-1391
Country	:	US
Telephone Number	:	225-320-3223
Fax Number	:	225-380-2196

Provider Business Practice Location Address
First Line	:	1234 DEL ESTE AVE STE 602
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4828
Country	:	US
Telephone Number	:	225-320-3223
Fax Number	:	225-380-2196

Authorized Official
Title or Position	:	OWNER, THERAPIST
Name	:	MELISSA SEPEDA
Credential	:	LCSW
Telephone Number	:	225-320-3223

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/29/2019

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