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NPI Code Detail

MEDICARE: MS. JANIE BRYNOLF LCSW, CAC

MEDICARE:  MS. JANIE  BRYNOLF  LCSW, CAC
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
1104100000XSocial Worker
21041C0700XClinical Social Worker6801098084MI
31041C0700XClinical Social WorkerSW15094FL

General Provider Information

NPI Number : 1104192400
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANIE BRYNOLF LCSW, CAC
Provider Business Mailing Address
First Line : 25078 PURPLE EMPEROR WAY
Second Line :
City : PUNTA GORDA
State : FL
Zip : 33955-6220
Country : US
Telephone Number : 810-845-6090
Fax Number :
Provider Business Practice Location Address
First Line : 25078 PURPLE EMPEROR WAY
Second Line :
City : PUNTA GORDA
State : FL
Zip : 33955-6220
Country : US
Telephone Number : 810-845-6090
Fax Number : 941-467-1743
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2012
Last Update Date : 02/28/2019

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Directions to “ MS. JANIE BRYNOLF LCSW, CAC” Practice Location

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