Provider Demographics
NPI:1245293497
Name:BRUEL, IRIS GOLDSTEIN (PHD)
Entity type:Individual
Prefix:DR
First Name:IRIS
Middle Name:GOLDSTEIN
Last Name:BRUEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7800 RED ROAD
Mailing Address - Street 2:PENTHOUSE 310
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-444-6005
Mailing Address - Fax:305-443-2908
Practice Address - Street 1:7800 RED ROAD
Practice Address - Street 2:PENTHOUSE 310
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-444-6005
Practice Address - Fax:305-443-2908
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPY20831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74189OtherBLUE CROSS BLUE SHIELD