Provider Demographics
NPI:1194080895
Name:DOMINICA J. DEBRAUWERE LCSW, DCSW, INC.
Entity type:Organization
Organization Name:DOMINICA J. DEBRAUWERE LCSW, DCSW, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOMINICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEBRAUWERE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, DCSW
Authorized Official - Phone:850-443-9801
Mailing Address - Street 1:2584 GOVERNORS CT
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-6399
Mailing Address - Country:US
Mailing Address - Phone:850-443-9801
Mailing Address - Fax:850-893-6013
Practice Address - Street 1:4284 KELSON AVE.
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-6399
Practice Address - Country:US
Practice Address - Phone:850-443-9801
Practice Address - Fax:850-526-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 33071041C0700X
FL33071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1356423537OtherNPI