Provider Demographics
NPI:1558671420
Name:BRAZIL, BRENDA ANN (MFT)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ANN
Last Name:BRAZIL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-4461
Mailing Address - Country:US
Mailing Address - Phone:707-431-8438
Mailing Address - Fax:
Practice Address - Street 1:443 HUDSON ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-4461
Practice Address - Country:US
Practice Address - Phone:707-431-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46838106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist