Provider Demographics
NPI:1700409869
Name:STANERT, BREANNE HALL (MED, LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:HALL
Last Name:STANERT
Suffix:
Gender:F
Credentials:MED, LMHC, LPC
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:LEAH
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7957 SILVER MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-2826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:358 STILES AVE # B
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4012
Practice Address - Country:US
Practice Address - Phone:904-264-8311
Practice Address - Fax:904-264-8377
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007887101Y00000X
FL17550101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor