1750354395 NPI number — STEPHEN ANTHONY BRUNETTI LCSW

Table of content: STEPHEN ANTHONY BRUNETTI LCSW (NPI 1750354395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750354395 NPI number — STEPHEN ANTHONY BRUNETTI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNETTI
Provider First Name:
STEPHEN
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

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:
1750354395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 472
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATRONA HEIGHTS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15065-0472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-845-9880
Provider Business Mailing Address Fax Number:
724-353-1083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1129 INDUSTRIAL PARK RD
Provider Second Line Business Practice Location Address:
MAILBOX #29 STE 211
Provider Business Practice Location Address City Name:
VANDERGRIFT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-845-9880
Provider Business Practice Location Address Fax Number:
724-353-1083
Provider Enumeration Date:
02/13/2006

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: 104100000X , with the licence number:  CW013339 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CW013339 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001861158 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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