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General NPI Number Information
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NPI Number | 1104177732
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Entity Type | Individual
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Provider Name | BRENNA SQUIRES PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2012
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Last Update Date | 02/23/2025
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Provider Practice Location Address
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Address Line | 5301 N FEDERAL HWY STE 270
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City | BOCA RATON
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State | FL
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Zip | 33487-4910
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Country | US
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Telephone | 561-241-6628
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Fax |
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Provider Business Mailing Address
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Address Line | 4522 W VILLAGE DR # 513
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City | TAMPA
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State | FL
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Zip | 33624-3429
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005715
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License Number State | VA
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