Provider Demographics
NPI:1801668728
Name:WHITE, BRI'ANNE M
Entity type:Individual
Prefix:
First Name:BRI'ANNE
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRI'ANNE
Other - Middle Name:
Other - Last Name:PONCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2101 SW BIRD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2193
Mailing Address - Country:US
Mailing Address - Phone:772-607-8043
Mailing Address - Fax:
Practice Address - Street 1:1801 SE HILLMOOR DR STE B-101
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7545
Practice Address - Country:US
Practice Address - Phone:772-607-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-306066106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician