Provider Demographics
NPI:1598436727
Name:BREWSTER, EWING RASHAWN
Entity Type:Individual
Prefix:
First Name:EWING
Middle Name:RASHAWN
Last Name:BREWSTER
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 1:10676 COLONIAL BOULEVARD
Mailing Address - Street 2:SUITE 30 #123
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913
Mailing Address - Country:US
Mailing Address - Phone:754-900-1525
Mailing Address - Fax:
Practice Address - Street 1:10676 COLONIAL BOULEVARD
Practice Address - Street 2:SUITE 30 #123
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913
Practice Address - Country:US
Practice Address - Phone:754-900-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist