Provider Demographics
NPI:1942815642
Name:ZALKA, BRENDA JOY MANN
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOY MANN
Last Name:ZALKA
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 1:1421 S OCEAN BLVD APT 416
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7399
Mailing Address - Country:US
Mailing Address - Phone:954-914-4734
Mailing Address - Fax:954-425-6408
Practice Address - Street 1:1600 S FEDERAL HWY STE 941
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7520
Practice Address - Country:US
Practice Address - Phone:954-914-4734
Practice Address - Fax:954-425-6408
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty