Healthcare Provider Details

I. General information

NPI: 1760145874
Provider Name (Legal Business Name): BRITTANY MARIE WEINER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12638 EARLY RUN LN
RIVERVIEW FL
33578-3324
US

IV. Provider business mailing address

12638 EARLY RUN LN
RIVERVIEW FL
33578-3324
US

V. Phone/Fax

Practice location:
  • Phone: 386-848-2805
  • Fax:
Mailing address:
  • Phone: 386-848-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: