Provider Demographics
NPI:1578255394
Name:BRUTUS, BLONDYNE MILAURE
Entity type:Individual
Prefix:
First Name:BLONDYNE
Middle Name:MILAURE
Last Name:BRUTUS
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 1:39 CARLA CT
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1401
Mailing Address - Country:US
Mailing Address - Phone:863-614-2294
Mailing Address - Fax:
Practice Address - Street 1:304 E PINE ST # 1252
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4969
Practice Address - Country:US
Practice Address - Phone:813-354-2715
Practice Address - Fax:813-354-2715
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician