Provider Demographics
NPI:1073294542
Name:MCKELVEY, BRENDA JAY (RBT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JAY
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 NW 80TH TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5755
Mailing Address - Country:US
Mailing Address - Phone:954-999-8768
Mailing Address - Fax:
Practice Address - Street 1:1046 NW 80TH TER
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5755
Practice Address - Country:US
Practice Address - Phone:954-999-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-284510106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician