Provider Demographics
NPI:1184792400
Name:BRESNAHAN, CARLA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:BRESNAHAN
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 1:2813 S HIAWASSEE RD
Mailing Address - Street 2:#207
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6300
Mailing Address - Country:US
Mailing Address - Phone:407-325-7546
Mailing Address - Fax:407-822-3702
Practice Address - Street 1:2813 S HIAWASSEE RD
Practice Address - Street 2:#207
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6300
Practice Address - Country:US
Practice Address - Phone:407-325-7546
Practice Address - Fax:407-822-3702
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health