Provider Demographics
NPI:1558646885
Name:THOMPSON, BRENDA MOSLEY
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:MOSLEY
Last Name:THOMPSON
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 1:7200 ALOMA AVE STE E2
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7133
Mailing Address - Country:US
Mailing Address - Phone:407-283-8358
Mailing Address - Fax:
Practice Address - Street 1:7200 ALOMA AVE STE E2
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7133
Practice Address - Country:US
Practice Address - Phone:497-283-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker