Provider Demographics
NPI:1689993198
Name:HINES, BRAINARD WILLEM (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRAINARD
Middle Name:WILLEM
Last Name:HINES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 NE OCEAN BLVD
Mailing Address - Street 2:#38B
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-2945
Mailing Address - Country:US
Mailing Address - Phone:305-804-4205
Mailing Address - Fax:305-675-9254
Practice Address - Street 1:2355 NE OCEAN BLVD
Practice Address - Street 2:#38B
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-2945
Practice Address - Country:US
Practice Address - Phone:305-804-4205
Practice Address - Fax:305-675-9254
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMHC 0612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health