Individual
BRUCE MARTY MIZENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.A.
Contact information
Practice address
3491 GANDY BLVD N STE 201, PINELLAS PARK, FL 33781-2654
(727) 547-0607
Mailing address
4811 20TH ST N, SAINT PETERSBURG, FL 33714-3310
(727) 710-2934
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
06/03/2015
Last updated
06/03/2015
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