| Doctor Name: | MR. DOUGLAS ROBERT BRATHOLT |
| NPI Number: | 1033455076 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | SW10586 |
| Business Practice Address: | 2900 Veterans Way Viera, FL - 329408007 |
| Business Phone Number: | 3216373788 |
| Business Fax Number: | |
| Mailing Address: | 2900 Veterans Way, Veterans Health Administration- Va Opc Hchv VIERA |
| State: | FL |
| Postal Code: | 32940 |
| Phone Number: | 3216373788 |
| Fax Number: | |
| NPI Enumeration Date: | 12/19/2012 |
| NPI Last Update Date: | 12/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | SW10586 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |