SOUL SPACE THERAPY, LLC (NPI# 1700354339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700354339 |
| Entity Type | Organization |
| Organization Name | SOUL SPACE THERAPY, LLC |
| Practice Address |
25078 Purple Emperor Way Punta Gorda FL 33955-6220 |
| Practice Telephone | 8108456090 |
| Practice Fax Number | 9414671723 |
| Mailing Telephone | 8108456090 |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-11-13 |
| Authorized Official Name | MS. JANIE JANINE BRYNOLF (OWNER/CLINICAL THERAPIST) |
| Authorized Official Telephone | 8108456090 |
| Authorized Official Credential | LCSW, CAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Street Address |
25078 PURPLE EMPEROR WAY |
| City | PUNTA GORDA |
| State | FL |
| Zip Code | 33955-6220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104192400 | Janie Brynolf | Social Worker | 25078 Purple Emperor Way, Punta Gorda, FL 33955-6220 | 2012-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447538699 | Dawn Raea Santiago | Occupational Therapist | 15360 Lemonade Dr, Punta Gorda, FL 33955 | 2011-07-21 |
| 1528408549 | Christina Frances Lipana | Speech-Language Pathologist | 612 Royal Poinciana, Punta Gorda, FL 33955-1027 | 2013-07-05 |
| 1104298439 | Joseph Bryan Lipana | Physical Therapist | 612 Royal Poinciana, Punta Gorda, FL 33955-1027 | 2015-10-26 |
| 1396088837 | Aileen Brandt | Counselor | 7444 S Seagrape Rd, Punta Gorda, FL 33955-1037 | 2013-04-03 |
| 1225561525 | Lorraine Ross | Specialist | 7529 Coco Plum, Punta Gorda, FL 33955-1051 | 2017-04-04 |
| 1376171496 | Andreea Nagy | Nurse Practitioner | 7400 S Blue Sage, Punta Gorda, FL 33955-1110 | 2020-04-01 |
| 1578952875 | Patrick Mathias Burke | Registered Nurse | 7196 N Plum Tree Unit 311, Punta Gorda, FL 33955-1119 | 2015-01-10 |
| 1427340116 | Adam Quinn | Counselor | 7560 Dracena, Punta Gorda, FL 33955-1171 | 2011-05-12 |
| 1255931325 | Jonathan Thomas Nusbaum | Physician Assistant | 26160 Angelica Rd, Punta Gorda, FL 33955-1419 | 2020-10-28 |
| 1790774719 | Janet E Clark | Anesthesiology | 3249 Sunset Key Cir, Punta Gorda, FL 33955-1969 | 2005-10-21 |
| Find all providers in zip 33955 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821587676 | Jennifer Nicholle Simms | Social Worker | 1700 Education Ave Bldg A, Punta Gorda, FL 33950-6222 | 2018-05-08 |
| 1417409723 | David Potts | Social Worker | 45991 Bermont Rd, Punta Gorda, FL 33982-9653 | 2016-11-03 |
| 1699125963 | Brittany Garrod | Social Worker | 25050 Sandhill Blvd Apt 3b3, Punta Gorda, FL 33983-5982 | 2016-06-17 |
| 1770735060 | Ruth Ann Sanchez | Social Worker | 24300 Airport Rd, Lot184, Punta Gorda, FL 33950-6909 | 2008-10-17 |
| 1164697710 | Gilbert Neal Kaufman | Social Worker | 26392 Explorer Rd, Punta Gorda, FL 33983-6314 | 2008-04-24 |
| 1972788669 | Harborside Psychiatric Services, LLC | Social Worker | 150 W. Mckenzie Street, Suite #117, Punta Gorda, FL 33950 | 2008-01-01 |
| 1083796304 | Margaret M Fox | Social Worker | 517 Tamiami Trail, Punta Gorda, FL 33950 | 2006-10-19 |
| 1013007145 | Amy Louise Houser | Social Worker | 26559 Barraquilla Avenue, Punta Gorda, FL 33983 | 2006-10-12 |
| 1285652370 | A Perrin Peterson | Social Worker | 27192 San Marino Dr, Punta Gorda, FL 33983-3127 | 2006-07-17 |
| 1811936115 | Tania Milagro Garcia | Social Worker | 2000 Rio De Janeiro Ave Ste 5, Punta Gorda, FL 33983-8649 | 2006-06-05 |
| Find all providers in PUNTA GORDA | ||||
| City | PUNTA GORDA |
| Zip Code | 33955 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.