Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY 7508 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 7508 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY 7508 | FL |
N | 103TP2701X | Group Psychotherapist | PY 7508 | FL |
NPI | 1114122462 |
---|---|
Provider Name | Dr. Brent Patrick Mruz |
First Address | Ocala, FL 34470-8022 |
Second Address | Ocala, FL 34470-8022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 09/01/2008 |