Provider Demographics
NPI:1104192400
Name:BRYNOLF, JANIE (LCSW, CAC)
Entity Type:Individual
Prefix:MS
First Name:JANIE
Middle Name:
Last Name:BRYNOLF
Suffix:
Gender:F
Credentials:LCSW, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25078 PURPLE EMPEROR WAY
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33955-6220
Mailing Address - Country:US
Mailing Address - Phone:810-845-6090
Mailing Address - Fax:
Practice Address - Street 1:25078 PURPLE EMPEROR WAY
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33955-6220
Practice Address - Country:US
Practice Address - Phone:810-845-6090
Practice Address - Fax:941-467-1743
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68010980841041C0700X
FLSW150941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker