Individual provider Active NPI

Brianna Kelly Jaworski, LMHC

  • Mental Health Counselor
  • Fort Myers, FL
National Provider Identifier
1932687167
Registry record updated Oct 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH16190 Issued in FL
Practice address
6361 Presidential CT Ste 101
Fort Myers, FL 33919-3583
Phone
(239) 360-1983
NPI assigned
Jul 31, 2018
Last updated
Oct 28, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU
Counselor 101Y00000X NU
Mental Health Counselor 101YM0800X MH16190 FL Primary
Health & Wellness Coach 171400000X FL

Addresses

Primary practice location

6361 Presidential CT Ste 101
Fort Myers, FL 33919-3583

Mailing address

6361 Presidential CT Ste 101
Fort Myers, FL 33919-3583
Phone (239) 360-1983

Other practice location 1

3403 Hancock Bridge Pkwy Ste 2
North Fort Myers, FL 33903-7056
Phone (239) 360-1983

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240501000176 FL Practitioner - Mental Health Counselor 3476993924 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6361 Presidential CT
Suite 104
Fort Myers, FL 33919-3583
Phone (239) 360-1976

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mandala Counseling Services LLC Mental Health CurrentSince Mar 2, 2024 Accepting new patients
The Onyx Counseling Center, LLC PastSince Oct 30, 2022 Accepting new patients
I-Bos Counseling Center, LLC Counselor PastSince Sep 1, 2021 Accepting new patients

Locations

6361 Presidential Ct
Ste 101
Fort Myers, FL 33919
Phone (239) 360-1976

6361 Presidential Ct
Ste 104
Fort Myers, FL 33919
Phone (239) 360-1976

3403 Hancock Bridge Pkwy
Ste 2
North Fort Myers, FL 33903
Phone (239) 360-1983

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1932687167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6361 PRESIDENTIAL CT STE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193583",
            "telephone_number": "239-360-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6361 PRESIDENTIAL CT STE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193583",
            "telephone_number": "239-360-1983"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3403 Hancock Bridge Pkwy Ste 2",
            "address_purpose": "LOCATION",
            "city": "North Fort Myers",
            "state": "FL",
            "postal_code": "339037056",
            "country_code": "US",
            "telephone_number": "239-360-1983",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAWORSKI",
        "first_name": "BRIANNA",
        "middle_name": "KELLY",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-31",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH16190",
            "primary": true
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.