Provider Demographics
NPI:1700409869
Name:STANERT, BREANNE HALL (MED, LMHC, LPC)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:HALL
Last Name:STANERT
Suffix:
Gender:F
Credentials:MED, LMHC, LPC
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:LEAH
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2054 CREEKMONT DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6874
Mailing Address - Country:US
Mailing Address - Phone:912-687-1661
Mailing Address - Fax:
Practice Address - Street 1:1845 TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-3356
Practice Address - Country:US
Practice Address - Phone:904-649-5175
Practice Address - Fax:904-452-7854
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007887101Y00000X
FL17550101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor