Provider Demographics
NPI:1619201704
Name:KING, BRENDA J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:298 N MAIN ST UNIT 417
Mailing Address - Street 2:
Mailing Address - City:NORTH UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01538-0620
Mailing Address - Country:US
Mailing Address - Phone:508-471-1765
Mailing Address - Fax:
Practice Address - Street 1:78 BURNCOAT STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-471-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10249103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7157OtherLICENSE