Doctor Name: | MR. PHILIP BRADLEY LONDRICO |
NPI Number: | 1053772301 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CDCA |
License Number: | 160078 |
Business Practice Address: | 246 Northland Dr Ste 200a Medina, OH - 442563440 |
Business Phone Number: | 3307259195 |
Business Fax Number: | 3307259187 |
Mailing Address: | 246 Northland Dr Ste 200a, MEDINA |
State: | OH |
Postal Code: | 442563440 |
Phone Number: | 3307259195 |
Fax Number: | 3307259187 |
NPI Enumeration Date: | 03/15/2016 |
NPI Last Update Date: | 03/24/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 160078 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |