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General NPI Number Information
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NPI Number | 1104192400
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Entity Type | Individual
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Provider Name | JANIE BRYNOLF LCSW, CAC
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Gender | Female
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 25078 PURPLE EMPEROR WAY
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City | PUNTA GORDA
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State | FL
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Zip | 33955-6220
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Country | US
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Telephone | 810-845-6090
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Fax | 941-467-1743
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Provider Business Mailing Address
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Address Line | 25078 PURPLE EMPEROR WAY
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City | PUNTA GORDA
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State | FL
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Zip | 33955-6220
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Country | US
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Telephone | 810-845-6090
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801098084
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW15094
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License Number State | FL
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