Provider Demographics
NPI:1265868129
Name:BRAKE, LINDSEY RYAN (LRT/CTRS)
Entity type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:RYAN
Last Name:BRAKE
Suffix:
Gender:F
Credentials:LRT/CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 MHRA 1111 SPRING GARDEN ST
Mailing Address - Street 2:BEYOND ACADEMICS, THE UNIVERSITY OF N.C. AT GREENSBORO
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27412-5013
Mailing Address - Country:US
Mailing Address - Phone:336-334-3855
Mailing Address - Fax:336-334-3361
Practice Address - Street 1:3607 MHRA 1111 SPRING GARDEN ST
Practice Address - Street 2:BEYOND ACADEMICS, THE UNIVERSITY OF N.C. AT GREENSBORO
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27412-5013
Practice Address - Country:US
Practice Address - Phone:336-334-3855
Practice Address - Fax:336-334-3361
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418760Medicaid