Provider Demographics
NPI:1467982439
Name:BUDNEY, BROOKE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:
Last Name:BUDNEY
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 1:120 ARROWHEAD WAY
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1065
Mailing Address - Country:US
Mailing Address - Phone:205-482-5668
Mailing Address - Fax:
Practice Address - Street 1:3399 SCENIC HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-4748
Practice Address - Country:US
Practice Address - Phone:205-482-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW115811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical