Provider Demographics
NPI:1770293052
Name:BRAZEN, SAMANTHA K (LMHC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:K
Last Name:BRAZEN
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 1:12937 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4114
Mailing Address - Country:US
Mailing Address - Phone:813-843-1056
Mailing Address - Fax:
Practice Address - Street 1:2430 ESTANCIA BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2644
Practice Address - Country:US
Practice Address - Phone:813-843-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21416101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health