Healthcare Provider Details

I. General information

NPI: 1447542758
Provider Name (Legal Business Name): JUDITH JOANNE DRISCOLL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3823 E STATE ROAD 64
BRADENTON FL
34208-9041
US

IV. Provider business mailing address

3823 E STATE ROAD 64
BRADENTON FL
34208-9041
US

V. Phone/Fax

Practice location:
  • Phone: 941-745-5111
  • Fax: 941-745-5667
Mailing address:
  • Phone: 941-745-5111
  • Fax: 941-745-5667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH4145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: