Marie Bracciale, PH.D. , LMFT, CAP

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MT 1604 Issued in FL

Practice address

600 Elizabeth PL
South Daytona, FL 32119-2824

Phone

(386) 322-6180

Fax

(386) 506-0008

NPI assigned

Oct 6, 2015

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1444089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444089600000",
    "number": "1134599921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1518",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321701518",
            "telephone_number": "386-383-4490",
            "fax_number": "386-506-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 ELIZABETH PL",
            "city": "SOUTH DAYTONA",
            "state": "FL",
            "postal_code": "321192824",
            "telephone_number": "386-322-6180",
            "fax_number": "386-506-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACCIALE",
        "first_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PH.D. , LMFT, CAP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-06",
        "last_updated": "2015-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "2517L CAP",
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "FL",
            "license": "481172 DOE",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT 1604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "765941500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in South Daytona, FL
• Providers in South Daytona, FL by specialty
• Marriage & Family Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; 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.