Provider Demographics
NPI:1396104766
Name:CUTLER, BRISMAYDA
Entity type:Individual
Prefix:
First Name:BRISMAYDA
Middle Name:
Last Name:CUTLER
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 1:25430 SW 126TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5832
Mailing Address - Country:US
Mailing Address - Phone:305-338-5003
Mailing Address - Fax:
Practice Address - Street 1:1120 NW 14TH ST RM 1210
Practice Address - Street 2:UNIVERSITY OF MIAMI/EARLY STEPS PROGRAM
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2107
Practice Address - Country:US
Practice Address - Phone:305-243-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid