1356423537 NPI number — MS. DOMINICA J. DEBRAUWERE MSW, LCSW,DCSW

Table of content: MS. DOMINICA J. DEBRAUWERE MSW, LCSW,DCSW (NPI 1356423537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356423537 NPI number — MS. DOMINICA J. DEBRAUWERE MSW, LCSW,DCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEBRAUWERE
Provider First Name:
DOMINICA
Provider Middle Name:
J.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW,DCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARROTT
Provider Other First Name:
DOMINICA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356423537
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2584 GOVERNORS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIANNA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32446-6399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-443-9801
Provider Business Mailing Address Fax Number:
850-893-6013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1535 KILLEARN CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE D-1
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32309-3467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-443-9801
Provider Business Practice Location Address Fax Number:
850-893-6013
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3307 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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