Healthcare Provider Details

I. General information

NPI: 1225646912
Provider Name (Legal Business Name): BREANNA LOUISE CALDWELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2020
Last Update Date: 07/19/2020
Certification Date: 07/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 WHIPPOORWILL LN
NAPLES FL
34105-3847
US

IV. Provider business mailing address

2791 64TH ST SW
NAPLES FL
34105-7335
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-4404
  • Fax:
Mailing address:
  • Phone: 814-806-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: