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Individual

JIM BRACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
209 N WILLOW AVE, TAMPA, FL 33606-1333
(813) 247-5433
(813) 248-2141
Mailing address
PO BOX 4772, TAMPA, FL 33677-4772
(813) 247-5433
(813) 248-2141

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW7075
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
766959300
FL
01
SW7075
SOCIAL WORKER
FL
Enumeration date
12/20/2006
Last updated
07/09/2007
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