Provider Demographics
NPI:1376414250
Name:VIZCARRA, BRYANNA DANIELLE (RMHCI)
Entity type:Individual
Prefix:
First Name:BRYANNA
Middle Name:DANIELLE
Last Name:VIZCARRA
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 SPRING PALMS LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5339
Mailing Address - Country:US
Mailing Address - Phone:772-913-4607
Mailing Address - Fax:
Practice Address - Street 1:11537 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5001
Practice Address - Country:US
Practice Address - Phone:407-821-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty