Active NPI
Myra J Brazell, LCSW
- Clinical Social Worker
- Orlando, FL
National Provider Identifier
1619925302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW 6899
- Practice address
- 5201 Raymond St
Orlando, FL 32803-8208 - Phone
- (407) 621-2639
- NPI assigned
- May 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW 6899 | FL | Primary |
Addresses
Primary practice location
5201 Raymond St
Orlando, FL 32803-8208
Mailing address
5201 Raymond St
Orlando, FL 32803-8208
Phone (407) 621-2639
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 767024900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW 6899 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356480000000",
"number": "1619925302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5201 RAYMOND ST",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328038208",
"telephone_number": "407-621-2639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5201 RAYMOND ST",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328038208",
"telephone_number": "407-621-2639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAZELL",
"first_name": "MYRA",
"middle_name": "J",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-04",
"last_updated": "2012-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW 6899",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "767024900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.