Individual
BRENT ALAN JEREMY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2525 20TH ST., VERO BEACH, FL 32960-3026
(772) 567-6508
Mailing address
5729 W 1ST SQ SW, VERO BEACH, FL 32968-2253
(772) 562-4852
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW 4445
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AH367Z
PTAN
FL
Enumeration date
05/07/2007
Last updated
02/10/2008
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