Provider Demographics
NPI:1457875890
Name:CLARKE, BRENDA JOY
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOY
Last Name:CLARKE
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 1:2066 NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8729
Mailing Address - Country:US
Mailing Address - Phone:352-638-5958
Mailing Address - Fax:
Practice Address - Street 1:17335 PAGONIA DR STE 109
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6011
Practice Address - Country:US
Practice Address - Phone:407-395-2032
Practice Address - Fax:352-432-0913
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst