Provider Demographics
NPI:1932687167
Name:JAWORSKI, BRIANNA KELLY (LMHC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:KELLY
Last Name:JAWORSKI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6361 PRESIDENTIAL CT STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3583
Mailing Address - Country:US
Mailing Address - Phone:239-360-1983
Mailing Address - Fax:
Practice Address - Street 1:6361 PRESIDENTIAL CT STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3583
Practice Address - Country:US
Practice Address - Phone:239-360-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 261QM0850X
FL171400000X
FLMH16190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171400000XOther Service ProvidersHealth & Wellness Coach
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health