Provider Demographics
NPI:1487304168
Name:HENLEY-PHILEMOND, BRITNEY SHARONDA
Entity type:Individual
Prefix:MRS
First Name:BRITNEY
Middle Name:SHARONDA
Last Name:HENLEY-PHILEMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 SW PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3626
Mailing Address - Country:US
Mailing Address - Phone:954-415-2588
Mailing Address - Fax:
Practice Address - Street 1:2449 SW FALCON CIR UNIT 239
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2923
Practice Address - Country:US
Practice Address - Phone:561-570-6132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNONEMedicaid