Provider Demographics
NPI:1861497471
Name:KOLITZ, BRENT PHILIP (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:PHILIP
Last Name:KOLITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 S DIXIE HWY STE 1260
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2945
Mailing Address - Country:US
Mailing Address - Phone:305-670-2284
Mailing Address - Fax:305-670-2285
Practice Address - Street 1:9350 S DIXIE HWY STE 1260
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2945
Practice Address - Country:US
Practice Address - Phone:305-670-2284
Practice Address - Fax:305-670-2285
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6344103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5296Medicare NSC