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General NPI Number Information
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NPI Number | 1265117105
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Entity Type | Individual
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Provider Name | MR. BREZHNEV THORPE
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Gender | Male
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 1503 S US HIGHWAY 301 STE E16
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City | TAMPA
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State | FL
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Zip | 33619-5126
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Country | US
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Telephone | 813-586-3106
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Fax | 813-274-9255
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Provider Business Mailing Address
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Address Line | 11705 BOYETTE RD # 248
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City | RIVERVIEW
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State | FL
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Zip | 33569-5533
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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