Provider Demographics
NPI:1336802131
Name:BRANSBURG, IRINA (MS, MA, RMFTI)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:BRANSBURG
Suffix:
Gender:F
Credentials:MS, MA, RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 SHERIDAN ST APT 16A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-7205
Mailing Address - Country:US
Mailing Address - Phone:305-778-2779
Mailing Address - Fax:
Practice Address - Street 1:932 PONCE DE LEON BLVD # A
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3010
Practice Address - Country:US
Practice Address - Phone:305-999-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3056101YM0800X
FLMT4683106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health