MEDICARE: BRANDON JERMAINE SWAILS

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
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1962839191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON JERMAINE SWAILS

Provider Business Mailing Address
First Line	:	73 LENOX AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026-3007
Country	:	US
Telephone Number	:	212-663-1975
Fax Number	:	212-663-1323

Provider Business Practice Location Address
First Line	:	73 LENOX AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026-3007
Country	:	US
Telephone Number	:	212-663-1975
Fax Number	:	212-663-1323

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

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	10/02/2013

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Directions to “ BRANDON JERMAINE SWAILS ” Practice Location

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