1275599433 NPI number — MRS. BRENDA JEANNE MICALI LMHC, LSP

Table of content: MRS. BRENDA JEANNE MICALI LMHC, LSP (NPI 1275599433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275599433 NPI number — MRS. BRENDA JEANNE MICALI LMHC, LSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICALI
Provider First Name:
BRENDA
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, LSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275599433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2904 CAPTAINS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMETTO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34221-5972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-721-3722
Provider Business Mailing Address Fax Number:
941-721-7253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 10TH AVE W
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
PALMETTO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34221-5047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-730-6083
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH 5476 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TS0200X , with the licence number: SS 510 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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