Provider Demographics
NPI:1326616236
Name:ASCANIO BRACAMONTE, WILLIAM ANTONIO A
Entity Type:Individual
Prefix:
First Name:WILLIAM ANTONIO
Middle Name:A
Last Name:ASCANIO BRACAMONTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18120 NW 68TH AVE APT B206
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-7905
Mailing Address - Country:US
Mailing Address - Phone:786-630-8601
Mailing Address - Fax:786-452-1200
Practice Address - Street 1:15924 SW 92ND AVE BAY FL33157
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1842
Practice Address - Country:US
Practice Address - Phone:305-964-5824
Practice Address - Fax:786-452-1200
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker