Provider Demographics
NPI:1316713399
Name:REISENBUECHLER, BROOKE ASPEN (MSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ASPEN
Last Name:REISENBUECHLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SIKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-4499
Mailing Address - Country:US
Mailing Address - Phone:863-687-8811
Mailing Address - Fax:
Practice Address - Street 1:4551 CAMINO REAL WAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1026
Practice Address - Country:US
Practice Address - Phone:239-275-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW18957101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty