Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY8916 | FL |
Y | 103T00000X | Psychologist | PY8916 | FL |
N | 103G00000X | Clinical Psychologist | PY8916 | FL |
N | 103TC0700X | Clinical Psychologist | PY8916 | FL |
NPI | 1013347277 |
---|---|
Provider Name | Chad Breznay |
First Address | Melbourne, FL 32902-1137 |
Second Address | Melbourne, FL 32935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2013 |
Last Update Date | 07/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100120900 | (05) | FL |