| Doctor Name: | DR. MARIE BRACCIALE |
| NPI Number: | 1134599921 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. , LMFT, CAP |
| License Number: | 2517L CAP |
| Business Practice Address: | 600 Elizabeth Pl South Daytona, FL - 321192824 |
| Business Phone Number: | 3863226180 |
| Business Fax Number: | 3865060008 |
| Mailing Address: | Po Box 1518, NEW SMYRNA BEACH |
| State: | FL |
| Postal Code: | 321701518 |
| Phone Number: | 3863834490 |
| Fax Number: | 3865060008 |
| NPI Enumeration Date: | 10/06/2015 |
| NPI Last Update Date: | 10/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 2517L CAP |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |