Individual
STACY BRATHWAITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2565 JUDGE FRAN JAMIESON WAY, VIERA, FL 32940-5998
(321) 409-2136
(321) 409-2140
Mailing address
2565 JUDGE FRAN JAMIESON WAY, VIERA, FL 32940-5998
(321) 409-2136
(321) 409-2140
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002562400
—
FL
Enumeration date
09/07/2010
Last updated
01/22/2013
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