Provider Demographics
NPI:1205375359
Name:BREGLER, BRANWYN L
Entity Type:Individual
Prefix:
First Name:BRANWYN
Middle Name:L
Last Name:BREGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4738 W CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8206
Mailing Address - Country:US
Mailing Address - Phone:813-767-1195
Mailing Address - Fax:800-713-8330
Practice Address - Street 1:2552 1ST AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8702
Practice Address - Country:US
Practice Address - Phone:727-545-1273
Practice Address - Fax:800-713-8330
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst