Provider Demographics
NPI:1114122462
Name:MRUZ, BRENT PATRICK (PSY D)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:PATRICK
Last Name:MRUZ
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 NE 42ND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-8022
Mailing Address - Country:US
Mailing Address - Phone:954-873-4847
Mailing Address - Fax:
Practice Address - Street 1:1701 NE 42ND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8022
Practice Address - Country:US
Practice Address - Phone:352-351-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7508103TC0700X, 103TC2200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy