Provider Demographics
NPI:1033287693
Name:BRUNKOW, KATHERINE A (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:BRUNKOW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 20TH ST NW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5906
Mailing Address - Country:US
Mailing Address - Phone:202-331-7250
Mailing Address - Fax:
Practice Address - Street 1:1400 20TH ST NW
Practice Address - Street 2:SUITE 104
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5906
Practice Address - Country:US
Practice Address - Phone:202-331-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3011211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490684Medicare ID - Type Unspecified