Provider Demographics
NPI:1225646912
Name:CALDWELL, BREANNA LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:LOUISE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 64TH ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-7335
Mailing Address - Country:US
Mailing Address - Phone:814-806-6629
Mailing Address - Fax:
Practice Address - Street 1:1095 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-3847
Practice Address - Country:US
Practice Address - Phone:239-261-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-19
Last Update Date:2020-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW174151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical