Healthcare Provider Details

I. General information

NPI: 1174864862
Provider Name (Legal Business Name): VENETTA BRATHWAITE MSW LCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 DOUGLAS AVE SUITE 208
ALTAMONTE SPRINGS FL
32714-5206
US

IV. Provider business mailing address

9429 NELSON PARK CIRCLE APT 103
ORLANDO FL
32817
US

V. Phone/Fax

Practice location:
  • Phone: 407-830-6412
  • Fax:
Mailing address:
  • Phone: 412-612-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberISW7630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: