NPIMap

Organization Active NPI

J Phyllis Brannen LCSW Cap

  • Clinical Social Worker
  • Melbourne, FL
National Provider Identifier
1073762415
Registry record updated Sep 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW6239 Issued in FL
Legal business name
J PHYLLIS BRANNEN LCSW CAP
Practice address
1503 Pine St
Melbourne, FL 32901-3120
Phone
(321) 953-3225
Fax
(321) 953-3252
NPI assigned
Sep 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
J Phyllis Brannen, LCSW CAP
Title
President
Phone
(321) 953-3225

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 2553L FL
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X SW6239 FL Primary

Addresses

Primary practice location

1503 Pine St
Melbourne, FL 32901-3120

Mailing address

1503 Pine St
Melbourne, FL 32901-3120
Phone (321) 953-3225

National Provider Directory

National Provider Directory
Tax ID family
Archway Counseling Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221004800000",
    "number": "1073762415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 PINE ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013120",
            "telephone_number": "321-953-3225",
            "fax_number": "321-953-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 PINE ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013120",
            "telephone_number": "321-953-3225",
            "fax_number": "321-953-3252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J PHYLLIS BRANNEN LCSW CAP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-10",
        "last_updated": "2008-09-10",
        "status": "A",
        "authorized_official_last_name": "BRANNEN",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "PHYLLIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-953-3225",
        "authorized_official_credential": "LCSW CAP"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "2553L",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW6239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.