Provider Demographics
NPI:1053144816
Name:PEREZ MORALES, BRENDA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PEREZ MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 ORIENTAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2441
Mailing Address - Country:US
Mailing Address - Phone:786-352-5051
Mailing Address - Fax:
Practice Address - Street 1:820 ORIENTAL BLVD
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2441
Practice Address - Country:US
Practice Address - Phone:786-352-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-133564106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty