Provider Demographics
NPI:1255456026
Name:BRATSEN, MARY LAYCOCK (LCSW, ACSW, DCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LAYCOCK
Last Name:BRATSEN
Suffix:
Gender:F
Credentials:LCSW, ACSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 GLENEAGLES CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2516
Mailing Address - Country:US
Mailing Address - Phone:321-632-1528
Mailing Address - Fax:
Practice Address - Street 1:2 SUNTREE PL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7689
Practice Address - Country:US
Practice Address - Phone:321-259-1883
Practice Address - Fax:321-259-2450
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW04201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical