Basic Information
| Provider Information | |||||||||
| NPI: | 1114441060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | BREANNE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MSW LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 N 3RD ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430555550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403497511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 ALAMANDA RD NE | ||||||||
| Address2: | |||||||||
| City: | PALM BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329054221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217231055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2017 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S1500925 | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SW15611 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.