Provider Demographics
NPI:1023558194
Name:BRANI, TRACEY
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:BRANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19503 S WEST VILLAGES PKWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5106
Mailing Address - Country:US
Mailing Address - Phone:813-720-7529
Mailing Address - Fax:941-681-2912
Practice Address - Street 1:19503 S WEST VILLAGES PKWY
Practice Address - Street 2:SUITE 11
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5106
Practice Address - Country:US
Practice Address - Phone:813-720-7529
Practice Address - Fax:941-681-2912
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician