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NPI Code Detail

MEDICARE: MRS. BRENDA VIDAL MS

MEDICARE: MRS. BRENDA VIDAL MS
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1N/AOTHERN/A

General Provider Information

NPI Number : 1467716878
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRENDA VIDAL MS
Provider Business Mailing Address
First Line : 5783 N.W VENITH DRIVE
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34986-3529
Country : US
Telephone Number : 754-368-3554
Fax Number :
Provider Business Practice Location Address
First Line : 817 N DIXIE HWY
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33060-5621
Country : US
Telephone Number : 954-785-8285
Fax Number : 954-928-0040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2012
Last Update Date : 06/29/2012

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Directions to “ MRS. BRENDA VIDAL MS” Practice Location

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