MEDICARE: BRANDI FROEBEL, LCSW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1023764479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDI FROEBEL, LCSW, LLC

Provider Business Mailing Address
First Line	:	4440 FORT SHAW DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-7314
Country	:	US
Telephone Number	:	813-751-4804
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 FORT SHAW DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-7314
Country	:	US
Telephone Number	:	813-751-4804
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRANDI SULLIVAN
Credential	:	LCSW
Telephone Number	:	813-751-4804

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	09/03/2024

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