Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 2517L CAP | FL |
N | 101YS0200X | School Counselor | 481172 DOE | FL |
NPI | 1134599921 |
---|---|
Provider Name | Dr. Marie Bracciale |
First Address | New Smyrna Beach, FL 32170-1518 |
Second Address | South Daytona, FL 32119-2824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2015 |
Last Update Date | 06/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
765941500 | (05) | FL |