Healthcare Provider Details

I. General information

NPI: 1205913977
Provider Name (Legal Business Name): BRENDA LEE KUCHINSKY P.H.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 IVES DAIRY RD BUILDING 2 SUITE 208
NORTH MIAMI BEACH FL
33179-2536
US

IV. Provider business mailing address

1011 IVES DAIRY RD BUILDING 2 SUITE 208
NORTH MIAMI BEACH FL
33179-2536
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-0098
  • Fax: 305-654-4412
Mailing address:
  • Phone: 305-653-0098
  • Fax: 305-654-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: