Provider Demographics
NPI:1174945323
Name:GERARD, BRAEDON (LCSW, CAP)
Entity type:Individual
Prefix:
First Name:BRAEDON
Middle Name:
Last Name:GERARD
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2233
Mailing Address - Country:US
Mailing Address - Phone:813-251-8437
Mailing Address - Fax:813-259-1415
Practice Address - Street 1:305 S HYDE PARK AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2233
Practice Address - Country:US
Practice Address - Phone:813-251-8437
Practice Address - Fax:813-259-1415
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 116921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical