1083791867 NPI number — MS. SHIRLEY JEAN BRUNER LCSWC

Table of content: MS. SHIRLEY JEAN BRUNER LCSWC (NPI 1083791867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083791867 NPI number — MS. SHIRLEY JEAN BRUNER LCSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNER
Provider First Name:
SHIRLEY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083791867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2336 GODDARD PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-334-6961
Provider Business Mailing Address Fax Number:
410-334-6960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2336 GODDARD PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-334-6961
Provider Business Practice Location Address Fax Number:
410-334-6960
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  03174 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 424426 . This is a "CAREFIRST BCBS PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 517251 . This is a "UHC MAMSI GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 724324 . This is a "NCPPO PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: LM49EA . This is a "CAREFIRST BCBS GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R968 . This is a "CAREFIRST FEDERAL GROUP" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 0011 . This is a "CAREFIRST FEDERAL PIN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 100053424001 . This is a "AMERICAN PSYCH SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2102153 . This is a "UNITED HEALTH CARE MAMSI" identifier . This identifiers is of the category "OTHER".




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