Provider Demographics
NPI:1376681874
Name:COON, BRENDA LYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LYN
Last Name:COON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93584-0149
Mailing Address - Country:US
Mailing Address - Phone:213-605-3820
Mailing Address - Fax:661-449-3772
Practice Address - Street 1:2323A E. PALMDALE BOULEVARD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550
Practice Address - Country:US
Practice Address - Phone:661-223-3800
Practice Address - Fax:661-537-2937
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 274421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW2983Medicare PIN