Healthcare Provider Details

I. General information

NPI: 1982609277
Provider Name (Legal Business Name): DEBRA BRANDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W GRANADA BLVD STE H
ORMOND BEACH FL
32174-5182
US

IV. Provider business mailing address

PO BOX 731164
ORMOND BEACH FL
32173-1164
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-9800
  • Fax: 386-673-1111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2761
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW2761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: