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Individual

DR. MARIE BRACCIALE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D. , LMFT, CAP

Contact information

Practice address
600 ELIZABETH PL, SOUTH DAYTONA, FL 32119-2824
(386) 322-6180
(386) 506-0008
Mailing address
PO BOX 1518, NEW SMYRNA BEACH, FL 32170-1518
(386) 383-4490
(386) 506-0008

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2517L CAP
FL
101YS0200X
School Counselor
481172 DOE
FL
106H00000X
Marriage & Family Therapist
Primary
MT 1604
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
765941500
FL
Enumeration date
10/06/2015
Last updated
10/06/2015
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