Individual
DIANE K. BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1601 SW ARCHER RD, GAINESVILLE, FL 32608-1197
(352) 548-6000
Mailing address
1601 SW ARCHER RD, GAINESVILLE, FL 32608-1197
(352) 548-6000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW 7796
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
768315400
—
FL
01
—
U5996Y
MEDICARE PTAN
FL
Enumeration date
08/05/2006
Last updated
04/06/2022
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