Janie Brynolf, LCSW, CAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW15094 Issued in FL

Practice address

25078 Purple Emperor Way
Punta Gorda, FL 33955-6220

Phone

(810) 845-6090

Fax

(941) 467-1743

NPI assigned

Mar 30, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Soul Space Therapy, LLC

  • Clinical Social Worker
  • Punta Gorda, FL
  • NPI 1700354339

  MI

  Medicare reassignment NPD Authorized official
• Alternative Community Living, Inc.

  dba Hope Network - New Passages

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Saginaw, MI
  • NPI 1487008652
  NPD (past)

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

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551312000000",
    "number": "1104192400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25078 PURPLE EMPEROR WAY",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339556220",
            "telephone_number": "810-845-6090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25078 PURPLE EMPEROR WAY",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339556220",
            "telephone_number": "810-845-6090",
            "fax_number": "941-467-1743"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1110 Eldon Baker Dr",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485071923",
            "country_code": "US",
            "telephone_number": "810-232-2766",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRYNOLF",
        "first_name": "JANIE",
        "name_prefix": "Ms.",
        "credential": "LCSW, CAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-30",
        "last_updated": "2019-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801098084",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW15094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mila De la Caridad Broche Coego
• Brookdale Senior Living Communities, Inc. (Brookdale Punta Gorda Isles)
• Scarlet Marie Brown, OT
• Victoria Brown, BSN, RN, CPN
• Branda Brunel, LCSW
• Deborah Burgess, MS, LMHC
• Patrick Mathias Burke
• Jason Burns, DPT
• Burnt Store Family Medicine P L
• Melody H Burt, DO

• Clinical Social Worker in Punta Gorda, FL
• Providers in Punta Gorda, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.