Provider Demographics
NPI:1134934961
Name:FALCONE, BRENDA MARIE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:FALCONE
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 1:60684 LILAC RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-9296
Mailing Address - Country:US
Mailing Address - Phone:574-229-7763
Mailing Address - Fax:
Practice Address - Street 1:3575 MOREAU CT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-4387
Practice Address - Country:US
Practice Address - Phone:574-229-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33006792A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker