Provider Demographics
NPI:1356423537
Name:DEBRAUWERE, DOMINICA J (MSW, LCSW,DCSW)
Entity type:Individual
Prefix:MS
First Name:DOMINICA
Middle Name:J
Last Name:DEBRAUWERE
Suffix:
Gender:F
Credentials:MSW, LCSW,DCSW
Other - Prefix:MS
Other - First Name:DOMINICA
Other - Middle Name:J
Other - Last Name:PARROTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2584 GOVERNORS CT
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-6399
Mailing Address - Country:US
Mailing Address - Phone:850-443-9801
Mailing Address - Fax:850-893-6013
Practice Address - Street 1:1535 KILLEARN CENTER BLVD
Practice Address - Street 2:SUITE D-1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3467
Practice Address - Country:US
Practice Address - Phone:850-443-9801
Practice Address - Fax:850-893-6013
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical