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NPI Code Detail

MEDICARE: ALLISON BRAZENDALE PSY.D.

MEDICARE: ALLISON BRAZENDALE PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1319SC

General Provider Information

NPI Number : 1629468491
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLISON BRAZENDALE PSY.D.
Provider Business Mailing Address
First Line : 6275 NW 96TH TER
Second Line :
City : PARKLAND
State : FL
Zip : 33076-1815
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1505 BLANDING ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29201-2906
Country : US
Telephone Number : 954-913-6306
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2015
Last Update Date : 04/08/2019

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