Provider Demographics
NPI:1760686422
Name:VANBRACKLE, CATHRYN ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CATHRYN
Middle Name:ELIZABETH
Last Name:VANBRACKLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JIMMY ANN DRIVE
Mailing Address - Street 2:#1918
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114
Mailing Address - Country:US
Mailing Address - Phone:305-331-2553
Mailing Address - Fax:
Practice Address - Street 1:600 JIMMY ANN DR
Practice Address - Street 2:#1918
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-7407
Practice Address - Country:US
Practice Address - Phone:305-331-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7396103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist