Provider Demographics
NPI:1144586603
Name:BRIGNONI, DEINA MICHELLE (IMT)
Entity Type:Individual
Prefix:
First Name:DEINA
Middle Name:MICHELLE
Last Name:BRIGNONI
Suffix:
Gender:F
Credentials:IMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E MAUD ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3249
Mailing Address - Country:US
Mailing Address - Phone:352-253-9348
Mailing Address - Fax:352-253-9351
Practice Address - Street 1:101 E MAUD ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3249
Practice Address - Country:US
Practice Address - Phone:352-253-9348
Practice Address - Fax:352-253-9351
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health