MEDICARE: MR. DREW ROBERT HIMES LCSW, CAADC

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	17086	PA
2	1041C0700X	Clinical Social Worker	CW022737	PA

General Provider Information

NPI Number	:	1851062319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DREW ROBERT HIMES LCSW, CAADC

Provider Business Mailing Address
First Line	:	1932 W 8TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4937
Country	:	US
Telephone Number	:	814-455-4009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1932 W 8TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4937
Country	:	US
Telephone Number	:	814-455-4009
Fax Number	:

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

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	05/27/2022

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