Provider Demographics
NPI:1366445553
Name:BRAKEL, JOY (LCSW)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:BRAKEL
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 1:1300 DOUGLAS CIR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4536
Mailing Address - Country:US
Mailing Address - Phone:305-293-4861
Mailing Address - Fax:305-293-4813
Practice Address - Street 1:1300 DOUGLAS CIR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4536
Practice Address - Country:US
Practice Address - Phone:305-293-4861
Practice Address - Fax:305-293-4813
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-03-17
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
FLSW118711041C0700X
MELC5269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEBR ME 0676Medicare ID - Type UnspecifiedLCSW/LADC/CCS