Provider Demographics
NPI:1275588402
Name:BRAUNSTEIN, COLETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:BRAUNSTEIN
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 1:749 STATE ROAD 60 E
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4240
Mailing Address - Country:US
Mailing Address - Phone:863-676-3136
Mailing Address - Fax:863-678-0263
Practice Address - Street 1:749 STATE ROAD 60 E
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4240
Practice Address - Country:US
Practice Address - Phone:863-676-3136
Practice Address - Fax:863-678-0263
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW78931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768565300Medicaid
FLZ092ZMedicare ID - Type Unspecified