Provider Demographics
NPI:1902334907
Name:BRANTLEY, REGINALD ROZELL (MCAP)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:ROZELL
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 N ORANGE AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2459
Mailing Address - Country:US
Mailing Address - Phone:407-488-1809
Mailing Address - Fax:407-236-0826
Practice Address - Street 1:37 N ORANGE AVE STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2459
Practice Address - Country:US
Practice Address - Phone:407-488-1809
Practice Address - Fax:407-236-0826
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP100050101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)