Provider Demographics
NPI:1740737717
Name:BRENKER, DARA (MS)
Entity type:Individual
Prefix:MS
First Name:DARA
Middle Name:
Last Name:BRENKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 LAKE MONTEREY CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8446
Mailing Address - Country:US
Mailing Address - Phone:954-263-3412
Mailing Address - Fax:
Practice Address - Street 1:15200 JOG RD
Practice Address - Street 2:SUITE 303
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446
Practice Address - Country:US
Practice Address - Phone:561-503-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH13342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health