Provider Demographics
NPI:1710566070
Name:BRZINSKI, MONTANA LYNN I
Entity Type:Individual
Prefix:
First Name:MONTANA
Middle Name:LYNN
Last Name:BRZINSKI
Suffix:I
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 1:4625 LEGENDS LN
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:FL
Mailing Address - Zip Code:32033-2058
Mailing Address - Country:US
Mailing Address - Phone:904-806-6615
Mailing Address - Fax:
Practice Address - Street 1:4625 LEGENDS LN
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:FL
Practice Address - Zip Code:32033-2058
Practice Address - Country:US
Practice Address - Phone:904-806-6615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-155220106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician