Provider Demographics
NPI:1659324523
Name:SOUTH BREVARD WOMEN'S CENTER, INC
Entity Type:Organization
Organization Name:SOUTH BREVARD WOMEN'S CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-242-3110
Mailing Address - Street 1:1425 AURORA RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5384
Mailing Address - Country:US
Mailing Address - Phone:321-242-1526
Mailing Address - Fax:321-242-7464
Practice Address - Street 1:1425 AURORA RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5384
Practice Address - Country:US
Practice Address - Phone:321-242-1526
Practice Address - Fax:321-242-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty