Provider Demographics
NPI:1952867186
Name:VANBUSKIRK, BRIANNE (RCSWI)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 COLONNADES CT W APT 135
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7880
Mailing Address - Country:US
Mailing Address - Phone:810-537-2089
Mailing Address - Fax:
Practice Address - Street 1:9241 PARK ROYAL DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9204
Practice Address - Country:US
Practice Address - Phone:239-985-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW123521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical