Provider Demographics
NPI:1619676772
Name:MOJENA, BRENDA LIZT
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LIZT
Last Name:MOJENA
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 1:14917 SW 38TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-3938
Mailing Address - Country:US
Mailing Address - Phone:786-616-1696
Mailing Address - Fax:
Practice Address - Street 1:14917 SW 38TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-3938
Practice Address - Country:US
Practice Address - Phone:786-616-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22244692106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician